Predictive value of total leucocyte count (TLC), bilirubin and C-reactive protein in the diagnosis of gangrenous and perforated appendicitis.

摘要

Acute appendicitis is the most common cause of acute abdomen. Most of thecases are diagnosed on history, clinical examination and raised TLC but gangrenous andperforated appendicitis are difficult to diagnose. The TLC, Serum bilirubin and C?reactiveprotein (CRP) have been shown to indicate perforation in appendicitis. Objectives: The purposeof this study was to evaluate the role of TLC, hyperbilirubinemia and CRP in the diagnosisof perforated appendix and surgery should be planned. Study Design: Prospective study.Setting: Department of Surgery in Sheikh Zayed Medical College Rahim Yar Khan. Period:12 months from November 2017 to October 2018. Material & Methods: This study consistedof patients admitted with the clinical suspicion of acute appendicitis. ALVARADO score wascalculated. 120 patients with ALVARADO score more than 6 and histologically diagnosedappendicitis were finally included in the study. A proforma was filled which included patientsname, age, sex, duration of pain, TLC count, C-Reactive protein (CRP) level and serum totalbilirubin level and diagnosis of appendicitis (acute appendicitis, gangrenous appendicitis andperforated appendicitis. Patients were divided into 3 groups. Group A comprised of patientswith features of simple appendicitis (AA), Group B Gangrenous appendicitis (GA) and groupC Perforated appendicitis (PA). Results: There were 81 patients of acute appendicitis, 13patients of gangrenous appendicitis and 26 patients of perforated appendicitis. TLC was raisedin 13 patients of AA, 10 patients of gangrenous appendicitis and 24 patients of perforatedappendicitis. Hyperbillirubinemia (1mg/dl) was present in 9 patients of GA and 20 patients ofPA. Raised C-Reactive protein level (5mg) was present in 10 patients of GA and 21 patients ofPA. There was significant correlation of raised TLC, hyperbillirubinemia and C-reactive proteinin gangrenous and perforated appendicitis and p value was less than 0.05. Predictive valueof bilirubin in GA and PA was 56.25 % and 74.04 %respectively. Predictive value of C ReactiveProtein in GA and PA was 41.66 and 60 respectively. Predictive value of TLC in GA and PAwas 43.47 and 60.86 respectively. Conclusion: All the patients who present with pain in rightiliac fossa, lower abdominal tenderness and rigidity, Alvarado score7, raised TLC, CRP andhybillirubinemia are the suspected case of perforated appendix and should be aggressivelyresuscitated and operated.