title: The SLAPPA (significance of lower abdominal/periumbilical piercing as a predictor of acute appendicitis) audit.
abstract: BACKGROUND
  Anecdotal observations among medical staff suggest that young women with periumbilical piercing presenting with right iliac fossa pain are more likely to have pelvic inflammatory disease than acute appendicitis because of an unconventional lifestyle. This audit was performed to test the validity of this prejudice.
  
  
  METHODS
  The clinical data of all female patients aged 16-45 years admitted to a teaching hospital with suspected acute appendicitis were collected prospectively over six months. Patients who had undergone previous appendicectomy or gynaecological surgery, those with known Crohn's disease, or those on antibiotics at the time of admission were excluded.
  
  
  RESULTS
  107 patients with a median age of 29.7 years (range 15-45 years) were studied. Thirty-two patients had periumbilical piercing (Group A) and 75 patients did not (Group B). Fifty-nine out of 107 (55.14%) were operated upon. Ten (31.2%) patients in Group A had histologically confirmed acute appendicitis compared with 25 (33.3%) in Group B. Other diagnoses in Group A included non-specific abdominal pain (n = 13, 40.6%), urinary tract infection (4, 12.5%), pelvic inflammatory disease (4, 12.5%) and ovarian cyst (1, 3.1%). Corresponding figures for patients in Group B were 30 (40.0%), 8 (10.7%), 7 (9.3%) and 4 (5.3%) respectively. None of the differences between the two groups were statistically significant.
  
  
  CONCLUSIONS
  There was no difference in the frequency of a final diagnosis of acute appendicitis or pelvic inflammatory disease in female patients with and without periumbilical piercing. Health care professionals should not allow their clinical judgment to be prejudiced by the presence of body piercing.
authors.forename: Irfan
authors.initials: I
authors.lastname: Ahmed
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Boulter
authors.forename: Dileep N
authors.initials: DN
authors.lastname: Lobo
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology; D034861:Abdominal Wall / Q000473:pathology*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D046288:Body Piercing / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D016387:Women's Health