Leucocytosis as a diagnostic tool in acute appendicitis for borderline (5-6) and probable diagnosis (7-8) mantrels scores

Jan Mohammad Rather ., Sobia Manzoor., Adil pervaiz shah and Ajaz Ahmad Rather

Background: Acute appendicitis constitutes the most common cause of non-traumatic acute abdomen in the world. Patients with borderline MANTRELS score of 5-6 require a CT abdomen to finally clinch the diagnosis. CT availability may not always be possible in resource limited centres and third world countries leading to difficulty in diagnosis.

Methods: An analytical study was conducted to find out the diagnostic accuracy of leukocytosis in predicting acute appendicitis in patients undergoing emergency appendectomy who have borderline MANTRELS scores of 5-6 and 7-8 (probable appendicitis). The degree of inflammation of the resected specimens was grossly assessed and graded into acute appendicitis, complicated appendicitis (such as gangrene, perforation, and abscess) and normal or negative appendix. The operative findings were correlated with leukocyte counts using 2 x 2 tables.

Results: Out of 100 appendectomies, with exclusion of the negative appendectomies there were 70% patients with elevated leukocyte count. The overall sensitivity, specificity, positive predictive value and negative predictive value of elevated leukocyte counts for inflamed appendix were 84.33%, 70.5%, 93.33%, and 48% respectively.

Conclusions: We conclude that leucocytosis is helpful in the diagnosis of acute appendicitis especially in patients with Alvarado scores in the middle range, 5-8, and can b used a useful diagnostic tool in limited resource centres and third world countries with reasonable accuracy.

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