Irritable bowel syndrome and negative appendectomy: a prospective multivariable investigation.
OBJECTIVE
To examine prospectively whether irritable bowel syndrome (IBS) or other variables-that is, psychiatric profiles, health-related quality of life (HRQoL) and clinical features-are associated with negative appendectomy (NA).


METHODS
Longitudinal study.


METHODS
Inpatient and emergency service in a university-affiliated teaching hospital.


METHODS
430 consecutive patients underwent emergent surgery for suspected appendicitis.


METHODS
Rome-II IBS questionnaire; the Hospital Anxiety and Depression Scale; the Short-Form 36 survey; the clinical, pathological and CT findings.


RESULTS
The NA group (n = 68, 15.8%) was younger, with female predominance, higher prevalence of Rome-II IBS, higher anxiety/depression scores and lower levels of HRQoL than the positive appendectomy group. The patients with NA tended to have atypical presentations (absence of migration pain/fever/muscle guarding), lower white cell count and percentage of polymorphonuclear cells (PMNC) and lower rate of CT scan usage than the positive group. After multiple logistic regression, IBS (OR 2.17; 95% CI 1.14 to 4.24), degree of anxiety (OR 1.12; 95% CI 1.02 to 1.49), absence of migrating pain (OR 3.43; 95% CI 1.90 to 5.95)/muscle guarding (OR 3.72; 95% CI 2.07 to 6.70), a lower PMNC percentage (<75%; OR 3.05; 95% CI 1.69 to 5.51) and no CT scan usage (OR 2.32; 95% CI 1.27 to 4.26) were found to be the independent factors in predicting NA.


CONCLUSIONS
Both patient (IBS, anxiety, atypical presentation) and physician (low CT scan usage) factors are the independent determinants predicting NA. Physicians should be cautious before operating on or referring patients with IBS for appendectomy. CT scan should be considered in patients with suspected appendicitis, particularly in those with IBS and atypical clinical presentations.
Lu
Ching-Liang
CL
Division of Gastroenterology, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan 11217. cllu@vghtpe.gov.tw
Liu
Chun-Chu
CC
Fuh
Jong-Ling
JL
Liu
Pei-Yi
PY
Wu
Chew-Wun
CW
Chang
Full-Young
FY
Lee
Shou-Dong
SD
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D004630:Emergencies; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000523:psychology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*