title: The management of right iliac fossa pain - is timing everything?
abstract: BACKGROUND
  Right iliac fossa (RIF) pain remains the commonest clinical dilemma encountered by general surgeons. We prospectively audited the management of acute RIF pain, examining the relationship between symptom duration, use of pre-operative radiological imaging and patient outcome.
  
  
  METHODS
  Over a six-month period, 302 patients, median age 18 years, 59% female, were admitted with RIF pain. Symptoms, clinical findings and laboratory results were documented. Patient management, timing of radiological investigations and operations, and outcome were recorded prospectively.
  
  
  RESULTS
  Non-specific abdominal pain (26%), gynaecological (22%) and miscellaneous causes (14%) accounted for most admissions. Ultimately, 119 patients (39%) had appendicitis. Anorexia, tachycardia or rebound tenderness in the RIF significantly predicted a final diagnosis of appendicitis. Patients with perforated appendicitis (n = 29) had a longer duration of pre-hospital symptoms (median 50h) compared to those with simple appendicitis (median 17 h) (p<0.001). The use of pre-operative imaging resulted in an increased time to surgery but was not associated with increased post-operative morbidity or perforated appendicitis.
  
  
  CONCLUSIONS
  The majority of patients presenting to hospital with RIF pain did not have appendicitis. Increased duration of pre-hospital symptoms was the main factor associated with perforated appendicitis. However, increased in-hospital time to theatre was not associated with perforated appendicitis or post-operative morbidity.
authors.affiliation: Department of Surgery, Mid-Western Regional Hospital, University of Limerick, Limerick, Ireland.
authors.forename: D P
authors.initials: DP
authors.lastname: McCartan
authors.forename: F J
authors.initials: FJ
authors.lastname: Fleming
authors.forename: P A
authors.initials: PA
authors.lastname: Grace
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000601:surgery*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007085:Ilium; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000601:surgery*; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome