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CLINICOPATHOLOGICAL STUDY OF ACUTE APPEDDICITIS WITH SPECIAL REFERENCE TO THE ROLE OF WBC COUNT, C-REACTIVE PROTEIN (CRP), USG AND ALVARADO SCORE IN DIAGNOSIS

Background: Acute appendicitis is one of the commonest surgical emergencies in all ages. Diagnosis is mainly clinical, delay in diagnosis definitely increases the morbidity, mortality and cost of treatment, more aggressive surgical approach has resulted in increased white appendectomies.
Methods: A total 140 cases hospitalized with abdominal pain, suggestive of acute appendicitis on the basis of WBC count, C-Reactive protein (CRP), USG and Alvarado scoring system and were subsequently operated, were included in the present study in our institute.
Results: Males belonging to young age group of 21-30 were most commonly affected. Abdominal pain was seen in 100% of patients.Most of the patients of acute appendicitis presented with more than one of above symptoms. The most common presenting symptom was right iliac fossa pain affecting 96.19% of cases (migratory 62.86% and non-migratory 33.33%), followed by anorexia (78.10%) and nausea (66.67%). The other symptoms were fever (65.71%), vomiting (46.67%), constipation (28.57%), right sided flank pain (22.86%), dysurea (19.05%), suprapubic pain (15.24%), diarrhoea (14.29%) and generalized abdominal pain (13.33%) in decreasing order of frequency. Right iliac fossa pain was the most common presentation in non-appendicitis group, followed by anorexia. There was no significant difference in symptoms among these two groups.In this study 54.29% of patients with acute appendicitis had Alvarado score between 7 – 8 and 34.29% of patients with acute appendicitis had Alvarado score between 9 – 10. On the other hand majority of the patients of non-appendicitis group had a score below 7.
Conclusions: Young males are most commonly affected almost always presents with abdominal pain. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.