[An analysis of cases of missed acute appendicitis: for the time being there is no basis for a better policy].
Case reports of patients with acute appendicitis that was not recognised in time highlight the probability and the implications of significant complications. Early surgical treatment is dependent on early diagnosis, and this is usually the domain of general practice. With regard to the missed cases, it is important to see them in proper perspective: appendicitis is present in only a minority of all presentations of abdominal pain. General practitioners should refer 'liberally' in case of even minor signs or symptoms, so that appendicitis will be missed only in cases with a highly atypical presentation. It is important to realise that this happens, but it is not possible to draw conclusions from it that can serve as a guide to routine practice, as referral of all presentations of abdominal pain would be undesirable. There is a need to test the added value of diagnostic procedures like CRP and echography. However, until there is evidence that this could change the practice in atypical cases, practitioners can do no better than to reflect upon their faults.
Universitair Medisch Centrum St Radboud, afd. Huisartsgeneeskunde, Postbus 9101, 6500 HB Nijmegen. c.vanweel@hsv.kun.nl
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D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D013997:Time Factors