Towards an evidence-based management of right iliac fossa pain in the over 50-year-old patient.
Introduction Right iliac fossa pain is a common presenting complaint to general surgery. The differential diagnosis is wide, particularly in the elderly. Computed tomography (CT) is often used in the 'older' population, as they have a higher prevalence of acute colonic diverticulitis and colonic neoplasia, both of which should be identified prior to surgery. There is, however, no published evidence to support this practice. Methods We retrospectively reviewed the records of all patients aged over 50 years who presented with right iliac fossa (RIF) pain to a district general hospital. We determined whether tenderness was predominantly right- or left-sided and whether systemic inflammatory response syndrome (SIRS) was present on admission. The use of imaging modalities, their results and, if performed, operative findings were recorded. Results Of 3160 patients identified, 89 met the inclusion criteria. Diagnoses included appendicitis (27%), neoplasia (15%), non-specific abdominal pain (15%) and acute colonic diverticulitis (10%). CT was performed in 82% of patients, with a sensitivity of 97% based on operative findings. Six patients underwent surgery without a scan, two of whom required a change in the planned procedure due to unexpected findings. Conclusions Unless contraindicated, CT scanning should be mandatory in patients aged over 50 years presenting with signs of peritonism in the RIF or lower abdomen.
Buckinghamshire Healthcare NHS Trust , High Wycombe , UK.
E
E
Gammeri
John Radcliffe Hospital , Oxford , UK.
A
A
Catton
University College London , Stanmore , UK.
B H
BH
van Duren
Buckinghamshire Healthcare NHS Trust , High Wycombe , UK.
S G
SG
Appleton
Buckinghamshire Healthcare NHS Trust , High Wycombe , UK.
G I
GI
van Boxel
D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000209:etiology* / Q000601:surgery; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis; D004239:Diverticulitis, Colonic / Q000150:complications / Q000175:diagnosis; D019317:Evidence-Based Medicine / Q000379:methods; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology; D014057:Tomography, X-Ray Computed
Appendicitis; Computed tomography; Diverticulitis; Elderly; Over 50s; Right iliac fossa pain