V. Jeyaraman 1 , Arjun Pon Avudaiappan
BACKGROUND Acute appendicitis is still one of the commonest surgical emergencies. The clinical experience of the surgeon decides the accuracy of the diagnosis which is difficult in 30-40% of cases despite available diagnostic modalities. Apart from a careful history and clinical examination, blood inflammatory markers also help in the diagnosis and management of acute appendicitis. Various inflammatory markers have been estimated like white cell count, C Reactive Protein and polymorph percentage. The diagnostic accuracy of these markers varies in different reports. This study is conducted to estimate the role of sensitivity and specificity of total white cell count and C Reactive Protein in patients clinically diagnosed as suffering from acute appendicitis and their correlation with histopathology reports to assess their role in diagnosing severity of acute appendicitis. MATERIALS AND METHODS Patients admitted with clinical diagnosis of acute appendicitis were included in this study. Clinical examinations were made and the signs and symptoms were recorded in the proforma. Patients presenting with appendicular mass or abscess, treated conservatively and patients who refused to give consent were excluded from this study. Blood samples were collected on admission before surgery for estimation of total WBC count and CRP estimation. Then the patients underwent appendectomy and the resected appendicular specimens were sent for histopathological examination and the results were collected. Based on the histopathological report the cases were grouped under two categories complicated acute appendicitis and uncomplicated acute appendicitis depending on the presence or absence of perforation and gangrenous changes. Then the data were entered into excel 2007 and statistical analysis were made to find the significance of total white cell count and C reactive protein values in diagnosing acute appendicitis and their correlation with complication like perforation or gangrenous changes. RESULTS The total number of study subjects participated were 51 cases and among them 14 cases were complicated acute appendicitis and 37 cases were uncomplicated acute appendicitis. The age distribution was 26 cases (51%) were less than 25 years and 25 cases (49%) were 25 years and above. Out of the 51 cases 36 (70.6%) were males and 15 (29.4%) were females making a ratio of 2.4:1. Right iliac fossa pain and tenderness and Me Burney’s tenderness were present in all 51 cases (100%) while migratory pain was noticed only in 26 cases (50.9%). Guarding and rigidity were seen in 22 cases (43%). C reactive protein was positive in 41 cases (80.4%) and negative in 10 cases (19.6%). In complicated acute appendicitis C reactive protein values were >25 mg/dl in 13 cases (92.8%) and only in 14 cases (37.8%) in uncomplicated acute appendicitis group. Total white cell count was >11150 cells/cmm in 11 cases (78.5%) in complicated acute appendicitis and in uncomplicated acute appendicitis 15 cases (40.5%) only and making a total of 26 cases (51%). CONCLUSION In the present study pre-operative blood inflammatory marker C reactive protein was positive in significant number of cases and was markedly raised in complicated acute appendicitis. Total white cell count was significantly raised more in complicated acute appendicitis cases and to a lesser extent in uncomplicated acute appendicitis cases. Raised C reactive protein value is a good marker of acute appendicitis and a high C reactive protein value is a better indicator of a complicated acute appendicitis. Pre-operative C reactive protein estimation in cases of acute appendicitis helps in diagnosis as well as in grading the severity of acute appendicitis
