[Value of admission for observation in the management of acute abdominal right iliac fossa pain. Prospective study of 205 cases].
BACKGROUND
Because of the potential severity of acute appendicitis, many authors recommend the broad use of appendectomy. In this case, 15 to 20% of appendectomies are ultimately found to have been unnecessary. Hospital observation with repeated clinical and laboratory exams can be useful for patients with atypical clinical presentation. This paper assesses our approach, in which some patients with pain in the right iliac fossa (RIF) are admitted for observation before a decision about appendectomy.


METHODS
All patients (205 cases) admitted from March 2002 through February 2003 for acute abdominal pain of the RIF were included in this prospective study. The 120 women and 85 men (sex ratio=0.7) had a mean age of 27 years. We classified the patients into 3 groups: those who had an emergency appendectomy, those who had surgery after an observation period, and those discharged without appendectomy after observation.


RESULTS
The first group included 110 patients: 63% had a (rectal) temperature greater than 38 degrees C; 44% had guarding of the RIF and 87% elevated white blood cell counts (>10000/mm3). At surgery, appendicitis was diagnosed in 92%. After a mean delay of 36 hours of observation, 50 of the patients in the second group underwent surgery: 44% with (rectal) temperature > 38 degrees C, RIF guarding in 8%, and elevated white blood cell count (>10000/mm3) in 74%. In this group, 94% were diagnosed with appendicitis during surgery. Forty-five patients were discharged without surgery after 36 hours of observation.


CONCLUSIONS
In this study, pain and RIF guarding, associated with temperature greater than 38 degrees C and elevated white blood cell counts, were predictive of appendicitis in 96% of cases. Admission for observation of patients with atypical presentation avoided 45 unnecessary appendectomies (22%).
Service de Chirurgie Générale, Hôpital Mongi Slim, La Marsa, Tunisie. nafaa.arfa@rns.tn
Nafaa
N
Arfa
Lassaad
L
Gharbi
Lobna
L
Marsaoui
Sami
S
Ben Rhouma
Sameh
S
Farhati
Sirine
S
Bougamra
Saber
S
Mannai
Brahim
B
Ghariani
Hafedh
H
Mestiri
Mohamed Tahar
MT
Khalfallah
D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology*; D000208:Acute Disease; D000328:Adult; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005334:Fever; D007839:Functional Laterality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome