Study of predictive value of serum C- reactive protein in diagnosis of acute appendicitis

Background: Acute appendicitis is a common surgical condition and the most common cause of acute surgical abdomen. Commonly used tests for diagnosis of acute appendicitis were WBC, CRP ESR and procalcitonin (PCT) levels. In present study we correlated the serum levels of CRP with the histopathology of the removed appendix, to study predictive value of serum C- reactive protein in diagnosis of acute appendicitis. Material and Methods:Present study was conducted in patients with possibility of acute appendicitis, underwent appendicectomy. The histopathology report was considered as the final diagnosis. CRP more than 6 mg/dl was considered to be positive. Results: In present study total 88 patients were included. Male to female ratio was 1.4:1, most common age group was 21-30 years (35.23%) followed by 31-40 years (27.27%). Abdominal pain (92.05%), McBurney tenderness (80.68%), vomiting (76.14%), rebound tenderness (67.05%) and fever (55.68%) were common signs and symptoms noted in present study. On histopathology examination, inflammed appendix (51.14%) was most common finding, others were gangrenous appendix (23.86%), perforated appendix (5.68%) and normal appendix (19.32%). In present study diagnostic efficacy of serum CRP was sensitivity (80%), specificity (84.62%), positive predictive value (96.77%), negative predictive value (42.31%), diagnostic accuracy (80.68%). Conclusion. Serum CRP estimation is useful adjunct in diagnosis of acute appendicitis along with clinical diagnosis. Serum CRP value should be interpreted in combination with clinical findings.

Study of factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation

Background: Peptic ulcer disease in the general population had lifetime prevalence of 5-10% with incidence of 0.1–0.3% per year. Despite the tremendous improvement in preventive therapies, the rate of complication of this disease is still high and is burdened by high morbidity and mortality. In present study, we aimed to study factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation at our tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study conducted in patients admitted, diagnosed with duodenal ulcer perforation and surgically treated at our hospital. Results: In present study period total 56 patients were studied. All were male, most common age group was 51-60 years (37.5%) followed by 41-50 years (23.21%). Duration from onset of symptoms to admission was >24 hours (30.36%) in most of patients followed by 12-24 hours (28.57%). Most commons symptoms were pain in abdomen (100%), vomiting (100%). Anaemia (37.5%), LRTI and Pulmonary complications (19.64%), Diabetes mellitus (12.5%) and Hypertension (10.71%) were common comorbidities noted. Associated risk factors were previous history of PUD (41.07%), Alcohol use (64.29%), Cigarette smoking (51.79%) and Use of NSAIDs (12.5%). Presence of free gas under diaphragm was noted in 83.93% patients. Intraoperatively duodenal perforation diameter was 1–5 mm (60.71%) in most of patients followed by 6–10 mm (23.21%). Only 1 patient had duodenal perforation diameter was > 20mm. Common postoperative complications were wound infection (37.5%) and pulmonary infection (21.43%). In present study mortality within 1 month was noted in 13 patients (23.21%). Most common factors related to mortality were delayed presentation > 24 hours (61.54%), age > 60 years (46.15%), diabetes mellites (38.46%), Size of perforation > 1 cm (38.46%) and septicaemic shock (23.08%). Conclusion: Delayed presentation > 24 hours, age > 60 years size of perforation > 1 cm were common factors related to mortality in duodenal ulcer perforation patients.