ABSTRACT
Background: Diagnosis of acute appendicitis is mainly clinical and many scoring systems are being used
Objectives: To assess the reliability of caecal gurgling as clinical sign in the diagnosis of acute appendicitis in equivocal cases with Alvarado score of 5-6
Patients and Methods: This descriptive study was conducted in the department of General Surgery, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, from 1st September 2009 to 31st September 2012. All the patients were presented in OPD and emergency department with history of pain in right lower abdomen of short duration and have no co morbid condition. We divided the patients into three groups on the basis of Alvarado score. Group I with score 1-4, Group II with score 5-6, Group III with score 7 or above. Group II was further subdivided into Ila having no caecal gurgling and IIb having caecal gurgling on clinical examination. We calculated the rate of negative appendicectomies on histopathology in different groups. Data was entered and analyzed in SPSS version 15
Results: A total of the 840 patients were included in the study with age ranges from 12-60 years, out of which 67% were male. 185 patients fall in group I, 180 of which were managed conservatively successfully on oral medicine without admission. In group I only 5 patients needed to be operated and found appendicitis on histopathology. Group II included 286 patients, which was further subdivided into Group Ila [172 patients] having no caecal gurgling on examination and Group Ilb [114 patients] having caecal gurgling on clinical examination. Out of 172 patients of group Ila, 135 were operated and 24 negative appendicectomies were found on histopathology. While all 114 patients of group lib were operated and only 3 appendices were found normal on histopathology. In group III, 369 patients were recruited, all were operated and only 12 appendices were proved normal on histopathology report. So with the addition of caecal gurgling, in group II with equivocal cases having alvarado score 5- 6, there is decrease in rate of negative appedecectomies from nearly 17% reported in literature to 10.8% reported in this study
Conclusion: Appendicitis is the common surgical emergency and diagnosis is mainly clinical. Delay in diagnosis and proper treatment increases morbidity. Altered Alvarado scoring, with addition of caecal gurgling as a clinical sign, is slightly more reliable as compared to the conventional Alvarado scoring system especially in equivocal cases with score of 5-6