The management of right iliac fossa pain – Is timing everything?

• Published in: The surgeon (Edinburgh) Vol. 8; no. 4; pp. 211 - 217
• Main Authors: McCartan, D.P, Fleming, F.J, Grace, P.A
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01-08-2010
• Subjects: Abdominal Pain - diagnosis; Abdominal Pain - surgery; Acute appendicitis; Acute Disease; Adolescent; Adult; Appendectomy; Appendicitis - diagnosis; Appendicitis - surgery; Child; Diagnosis; Diagnosis, Differential; Female; Genital Diseases, Female - diagnosis; Genital Diseases, Female - surgery; Humans; Ilium; Intestinal Diseases - diagnosis; Intestinal Diseases - surgery; Laparoscopy; Logistic Models; Male; Prospective Studies; Right iliac fossa pain; Statistics, Nonparametric; Surgery; Treatment Outcome; Acute appendicitis; Right iliac fossa pain; Diagnosis
• ISSN: 1479-666X; 2405-5840
• DOI: 10.1016/j.surge.2009.11.008

Abstract Background Right iliac fossa (RIF) pain remains the commonest clinical dilemma encountered by general surgeons. We prospectively audited the management of acute RIF pain, examining the relationship between symptom duration, use of pre-operative radiological imaging and patient outcome. Methods Over a six-month period, 302 patients, median age 18 years, 59% female, were admitted with RIF pain. Symptoms, clinical findings and laboratory results were documented. Patient management, timing of radiological investigations and operations, and outcome were recorded prospectively. Results Non-specific abdominal pain (26%), gynaecological (22%) and miscellaneous causes (14%) accounted for most admissions. Ultimately, 119 patients (39%) had appendicitis. Anorexia, tachycardia or rebound tenderness in the RIF significantly predicted a final diagnosis of appendicitis. Patients with perforated appendicitis ( n = 29) had a longer duration of pre-hospital symptoms (median 50 h) compared to those with simple appendicitis (median 17 h) ( p < 0.001). The use of pre-operative imaging resulted in an increased time to surgery but was not associated with increased post-operative morbidity or perforated appendicitis. Conclusion The majority of patients presenting to hospital with RIF pain did not have appendicitis. Increased duration of pre-hospital symptoms was the main factor associated with perforated appendicitis. However, increased in-hospital time to theatre was not associated with perforated appendicitis or post-operative morbidity.