Is neutrophilia the key to diagnosing appendicitis in pregnancy?

Autor: Gentles JQ; Department of Surgery, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, BC, V5Z 1M9, Canada. Electronic address: gentles@alumni.ubc.ca., Meglei G; Department of Radiology, Providence Healthcare, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada. Electronic address: gaby.meglei@gmail.com., Chen L; Department of Surgery, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, BC, V5Z 1M9, Canada. Electronic address: leochen1@mail.ubc.ca., Hague CJ; Department of Radiology, Providence Healthcare, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada. Electronic address: cameron.Hague@vch.ca., Melck AL; Division of General Surgery, Providence Health Care, St Paul's Hospital, Room C303-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. Electronic address: amelck@providencehealth.bc.ca.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2020 May; Vol. 219 (5), pp. 855-859. Date of Electronic Publication: 2020 Mar 26.
DOI: 10.1016/j.amjsurg.2020.03.018
Abstrakt: Background: The diagnosis of acute appendicitis (AA) in pregnancy remains challenging. We investigated which preoperative clinical factors are most predictive of AA in pregnant women.
Methods: 164 pregnant patients undergoing magnetic resonance imaging for suspected AA were retrospectively reviewed. Logistic regression was used to compare those with pathologically confirmed AA and those without.
Results: 28 patients (17.1%) had pathologically confirmed AA. 42.9% (n = 12) were perforated at the time of operation. Factors associated with AA included history of emesis (p = 0.005), migratory abdominal pain (p = 0.006), rebound tenderness (p = 0.01), elevated white blood cell count (p = 0.003), elevated Alvarado Score (p < 0.001), elevated neutrophil count (p = 0.021), and left shift (p = 0.001). As a screening test, a left shift with neutrophils >70% provided a sensitivity and negative predictive value of 100.0%.
Discussion: Every patient in our series with AA had a left shift. Neutrophil count and percentage should be considered in the diagnostic evaluation of these patients to better guide resource utilization and treatment.
(Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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