Atypical presentation of appendicitis: diagnosis and management

ABSTRACT

To identify the patients with atypical features of acute appendicitis and to describe their management so as to avoid unnecessary delay in surgery. Descriptive study. Surgical Unit V, Civil Hospital and two private hospitals at Karachi, from July 2005 to June 2007. All patients who presented with right sided lower abdominal pain in whom provisional diagnosis of acute appendicitis made, were admitted for observation and further workup. The presenting symptoms, physical findings and total white count were entered on a proforma. Ultrasound, CT scan and laparoscopy were performed in atypical cases where available. A total of 318 patients were managed of whom 217 presented with classical features of appendicitis and 101 patients had atypical presentation. Diagnostic accuracy of ultrasound was 85%, CT scan 91% and laparoscopy 100%. One hundred and eighty patients had appendectomy in classical group and 80 patients in atypical group. Laparoscopic appendectomy was done in 26 patients. Nine patients required laparotomy. Ultrasound, CT scan and laparoscopy play an important role in diagnosis and management of atypical cases of appendicitis