Acute appendicitis mimics pelvic disease clinically in women of reproductive age

ABSTRACT

To analyze the clinical behaviour of acute appendicitis and pelvic disease in the women of reproductive age with special reference to ruptured right ovarian cyst/ectopic pregnancy. Study Observational. West Surgical Ward, Mayo Hospital Lahore. Duration January-June 2006. All the women >12 years of age with the physical signs of acute appendicitis were included in the study. Age ranged from 13-44 years with the mean of 21 [median 18] years. Anorexia and shifting of pain were hallmark of acute appendicitis while sudden severe localized pain in right iliac fossa and tachycardia without fever were more specific to ruptured ovarian cyst/ectopic pregnancy. Tenderness and rebound tenderness were common with varying in intensity in each of the two diseases. Appendicectomy was done in all patients by making Gridiron incision in 150[75%], muscle cutting in 31[15.5%] and Lanz's incision in 19[9.5%] patients. Retrocaecal appendix was found in 150[75%] and pelvic in 42[21%] patients. Ruptured right ovarian cyst was present in 11[5.5%], ruptured right ectopic pregnancy in 6[3%] and ovulation bleeding in 4[2%] patients. Morbidity observed in the study was 9.5% with no mortality. In the context of limited available medical imaging modalities, detailed history and good clinical performance are the main diagnostic tools with no increase in the rate of negative appendicectomy in developing countries