Muhammad Afzal, Liaquat Ali, Zaki Hussain, Zarin Afzal.
Negative appendicectomy.
Professional Med J Jan ;12(3):218-22.

To find out the rate of normal appendix in patients operated for clinically, diagnosed acute appendicitis. Design: Prospective study. Place and duration of study: Department of Surgery, Combined Military Hospital, Rawalpindi from 17 Feb 2001 to 08 Aug 2001. Patients and methods: One hundred consecutive patients of acute appendicitis diagnosed clinically were included in the study. All cases of appendicitis were operated within twenty-four hours of admission. All appendicectomies were sent for histopathological confirmation of diagnosis at Armed Forces Institute of Pathology Rawalpindi. Results: The mean age for patients was 30.6 year. Pain started in right iliac fossa in forty eight patients (48%), Paraumbilical in thirty eight patients (38%), in epigastrium in thirteen patients (13%) and right lumbar region in one patient (1%). Right iliac fossa tenderness was present in all hundred cases (100%) and rebound tenderness was present in seventy patients (70%). Temperature was normal in thirty-nine patients (39%) and raised in sixty-one patients (61%). Total Leucocyte Count more than 11000/cmm was found in sixty-six patients (66%). Appendicectomy was done in all cases and histopathology revealed seventy-nine inflammed appendices (79%) and twenty-one (21%) normal appendices. Conclusion: History and clinical examination is still the most reliable method in the diagnosis of acute appendicitis to reduce incidence of negative appendicectomy. However ultrasound and diagnostic laparoscopy are especially helpful to exclude acute appendicitis in women of childbearing age to avoid negative appendicectomy.

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