ABSTRACT
Objective: To determine the cause for pain right iliac fossa [RIF] after Appendectomy by Diagnostic laparoscopy in patients with normal investigations
Study Design: A Prospective Observational study
Place and Duration: Surgical A ward, Khyber Teaching Hospital Peshawar, from April 2009 to May 2011
Methodology: All those patient who continued to have pain in the RIF, more than 6 weeks after appendectomy,or more than 3 opd visits and normal investigations of genitourinary system and abdominopelvic ultrasound were included. Patients with symptoms of genitourinary system and pelvic inflammatory disease [PID] were excluded
Results: Fifty three patients were included in the study. Age range was from 15-42 years with 23 [43. 39%] patients aged less than 20 years, 15 [28.30%] 21-30 years,11 [20.75%] 31-40 years and 4 [7.54%] were above 40 years. Males were 19 [35.84%] and 34 [64.15%] were females, In 41 [77.35%] cases appendectomy had been done in emergency as they presented as acute appendicitis and 12 [22.64 %] were elective cases. Appendectomy was performed by open method in 45 cases [84.90%] and laparoscopically in 8 [15.09%] patients Diagnostic Laparoscopy was done in all patients and the findings included, adhesions in 21 cases [39.62%] tuberculosis in 9 cases [16.98%], PID in 7 cases [13.20%], ovarian cyst in 5 cases [9.43%] and a long appendicular stump in 2 [3.77%] and 1 [1.88%] terminal ileitis, while no cause was found in 8 [15.09%] patients
Conclusions: Post appendectomy pain RIF can be due to postoperative adhesions, pelvic inflammatory disease, ovarian cysts and abdominal tuberculosis. Diagnostic laparoscopy should be done to find out the cause in patients with inconclusive investigations