[Clinical examination remains the most important part of the diagnosis in suspected appendicitis].
This paper reports why the rate of unnecessary appendectomies can not be reduced exclusively by selected diagnostic laparoscopy. 75 women and 94 men greater than or equal to 16 years of age which had undergone appendectomy and/or diagnostic laparoscopy were analyzed for 19 clinical criteria in a retrospective study. We operated on 26 (17.0%) perforated, 100 (65.4%) acutely inflamed and 27 (17.6%) normal appendixes. 29 diagnostic laparoscopies showed 16 normal and 13 inflamed appendixes. 60 to 66% of the criteria had been evaluated. Important confirmatory signs and symptoms which would have allowed to establish a diagnosis had been overlooked very often. We did not find any sign or symptoms with discriminatory value. We conclude that a major cause of unnecessary appendectomies and imprecise indications for laparoscopy has been incomplete preoperative clinical examination.
Lehmann
K
K
Chirurgische Klinik, Kantonsspital Glarus.
Jenny
M
M
D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D010808:Physical Examination; D012189:Retrospective Studies
Bei Appendizitisverdacht bleibt die klinische Untersuchung der wesentlichste Bestandteil der Diagnose.