The significance of preoperative white blood cells count and ultrasonography for diagnosis of acute appendicitis

Majeed Al-Amiri
2011 unpublished
‫اﻟﺨﻼﺻﺔ‬ ‫اﻟﺪراﺳﺔ‬ ‫ﺗﻤﺖ‬ ‫ﻋﻠﻰ‬ 588 ‫ﻟﮭﻢ‬ ‫ﺗﻢ‬ ‫اﻟﺪودﯾﺔ،ﺟﻤﯿﻌﮭﻢ‬ ‫اﻟﺰاﺋﺪة‬ ‫اﻟﺘﮭﺎب‬ ‫ﺑﺎﻋﺮاض‬ ‫ﻣﺼﺎب‬ ‫ﻣﺮﯾﺾ‬ ‫اﻟﺜﺎﻧﻲ‬ ‫ﻛﺎﻧﻮن‬ ‫ﻣﻦ‬ ‫ﺳﻨﻮات‬ ‫ارﺑﻌﺔ‬ ‫،ﺧﻼل‬ ‫ﺟﺮاﺣﯿﺔ‬ ‫ﺑﻌﻤﻠﯿﺔ‬ ‫اﻟﺪودﯾﺔ‬ ‫اﻟﺰاﺋﺪﯾﺔ‬ ‫اﺳﺘﺌﺼﺎل‬ 2006-‫اﻟﻰ‬ ‫اﻟﺜﺎﻧﻲ‬ ‫ﻛﺎﻧﻮن‬ 2010. 366 ‫و‬ ‫ذﻛﺮ‬ ‫ﻣﺮﯾﺾ‬ 222 ‫ﺑﯿﻦ‬ ‫ﺗﺘﺮاوح‬ ‫اﻋﻤﺎرھﻢ‬ ،‫اﻧﺜﻰ‬ ‫ﻣﺮﯾﻀﺔ‬ 7-76 ‫ﺳﻨﺔ‬. ‫ا‬ ‫اﻟﺘﮭﺎب‬ ‫اﻋﺮاض‬ ‫ﻣﻦ‬ ‫ﯾﺸﻜﻮن‬ ‫ﺟﻤﯿﻌﮭﻢ‬ ‫اﻟﺠﮭﺔ‬ ‫اﺳﻔﻞ‬ ‫اﻟﻢ‬ ‫او‬ ‫اﻟﺴﺮة‬ ‫ﺣﻮل‬ ‫اﻟﻢ‬ ‫ﻣﺜﻼ‬ ‫اﻟﺪودﯾﺔ‬ ‫ﻟﺰاﺋﺪة‬ ‫اﻟﺦ‬ ‫ﻟﻼﻛﻞ‬ ‫اﻟﺸﮭﯿﺔ‬ ‫وﻋﺪم‬ ‫ﺗﻘﻲء‬ ‫ﻣﻊ‬ ‫اﻟﺒﻄﻦ‬ ‫ﻣﻦ‬ ‫اﻟﯿﻤﻨﻰ‬. ‫ﻟﺠﻤﯿﻌﮭﻢ‬
more » ... اﻟﯿﻤﻨﻰ‬. ‫ﻟﺠﻤﯿﻌﮭﻢ‬ ‫اﻟﺒﻄﻦ‬ ‫ﺳﻮﻧﺎر‬ ‫ﻓﺤﺺ‬ ‫اﺟﺮاء‬ ‫وﺗﻢ‬ , ‫ﻟﻠﻤﺴﺘﺸﻔﻰ‬ ‫اﻟﺘﺎﺑﻌﯿﻦ‬ ‫اﻟﻤﺨﺘﺒﺮ‬ ‫وﺷﻌﺒﺔ‬ ‫اﻻﺷﻌﺔ‬ ‫ﺷﻌﺒﺔ‬ ‫ﻓﻲ‬ ‫ﻟﮭﻢ‬ ‫اﻟﺒﯿﻀﺎء‬ ‫اﻟﺪم‬ ‫ﻛﺮﯾﺎت‬ ‫ﻋﺪد‬ ‫ﻓﺤﺺ‬ ‫واﺟﺮاء‬. ‫اﺟ‬ ‫اھﻤﯿﺔ‬ ‫ﻟﻤﻌﺮﻓﺔ‬ ‫اﻟﺪراﺳﺔ‬ ‫ھﺬة‬ ‫ﻣﻦ‬ ‫اﻟﮭﺪف‬ ‫اﻟﻤﺨﺘﺒﺮي‬ ‫اﻟﻔﺤﺺ‬ ‫واﺟﺮاء‬ ‫اﻟﺒﻄﻦ‬ ‫ﺳﻮﻧﺎر‬ ‫ﻓﺤﺺ‬ ‫ﺮاء‬ ‫اﻟﺪودﯾﺔ‬ ‫اﻟﺰاﺋﺪة‬ ‫اﻟﺘﮭﺎب‬ ‫ﺗﺸﺨﯿﺺ‬ ‫ﻟﻐﺮض‬ ‫اﻟﺒﯿﻀﺎء‬ ‫اﻟﺪم‬ ‫ﻛﺮﯾﺎت‬ ‫ﻟﻌﺪد‬. ‫اﻟﺪودﯾﺔ‬ ‫اﻟﺰاﺋﺪة‬ ‫اﺳﺘﺌﺼﺎل‬ ‫وﺗﻢ‬ ‫ﻋﺪﻣﺔ‬ ‫ﻣﻦ‬ ‫اﻟﺘﮭﺎﺑﮭﺎ‬ ‫ﺣﻘﯿﻘﺔ‬ ‫ﻣﻦ‬ ‫ﻟﻠﺘﺎﻛﺪ‬ ‫اﻟﻨﺴﯿﺠﻲ‬ ‫ﻟﻠﻔﺤﺺ‬ ‫اﻟﺰاﺋﺪة‬ ‫وارﺳﻠﺖ‬ ‫اﻟﻤﺮﺿﻰ‬ ‫ﻟﻜﻞ‬. ‫ھﻨﺎك‬ ‫وﻛﺎن‬ 102 ‫ﻣﺮﯾﺾ‬ , ‫اي‬ ‫ﺳﺎﻟﺒﺔ‬ ‫اﻟﻨﺴﯿﺠﻲ‬ ‫اﻟﻔﺤﺺ‬ ‫ﻧﺘﯿﺠﺔ‬ ‫ﻛﺎﻧﺖ‬ ‫ﺑﻨﺴﺒﺔ‬ % 346. 17. ‫وﻛﺎﻧﻮا‬ 42 ‫ﻣﺮﯾﺾ‬ ‫و‬ ‫ذﻛﺮ‬ 60 ‫اﻧﺜﻰ‬ ‫ﻣﺮﯾﻀﺔ‬. ‫ﻋﺪد‬ ‫ﻓﻲ‬ ‫ارﺗﻔﺎع‬ ‫ھﻨﺎك‬ ‫ﻛﺎن‬ ‫ﻛﻠﻤﺎ‬ ‫ﺗﻘﻞ‬ ‫ﺳﺎﻟﺒﺔ‬ ‫ﻋﻤﻠﯿﺔ‬ ‫اﺟﺮاء‬ ‫ﻧﺴﺒﺔ‬ ‫ان‬ ‫وﺗﺒﯿﻦ‬ ‫اﻟﺴﻮﻧﺎر‬ ‫ﺑﻮاﺳﻄﺔ‬ ‫اﻟﺪودﯾﺔ‬ ‫اﻟﺰاﺋﺪة‬ ‫اﻟﺘﮭﺎب‬ ‫ﻋﻠﻰ‬ ‫دﻻﺋﻞ‬ ‫وھﻨﺎك‬ ‫اﻟﺒﯿﻀﺎء‬ ‫اﻟﺪم‬ ‫ﻛﺮﯾﺎت‬. ‫وﺟﻮد‬ ‫وﺗﺒﯿﻦ‬ ‫ﻓﻲ‬ ‫ﻣﻮﺟﺒﺔ‬ ‫اﻟﻨﺴﯿﺠﻲ‬ ‫ﻟﻠﻔﺤﺺ‬ ‫ﻧﺘﯿﺠﺔ‬ 486 ‫ﺑﻨﺴﺒﺔ‬ ‫اي‬ ‫ﻣﺮﯾﺾ‬ % 653. 82. ‫ﻓﻲ‬ ‫ﻛﺎﻧﺖ‬ ‫اﻟﺪودﯾﺔ‬ ‫ﻟﻠﺰاﺋﺪة‬ ‫اﻟﻤﻮﺟﺒﺔ‬ ‫ﻟﻠﺤﺎﻻت‬ ‫اﻟﺪم‬ ‫ﻓﻲ‬ ‫اﻟﺒﯿﻀﺎء‬ ‫اﻟﺪم‬ ‫ﻛﺮﯾﺎت‬ ‫ﻋﺪد‬ ‫زﯾﺎدة‬ 388 ‫ﺑﻨﺴﺒﺔ‬ ‫اي‬ ‫ﻣﺮﯾﺾ‬ % 835. 79. ‫ﻓﻲ‬ ‫اﻟﺴﺎﻟﺒﺔ‬ ‫ﻟﻠﺤﺎﻻت‬ ‫اﻟﺪم‬ ‫ﻓﻲ‬ ‫اﻟﺒﯿﻀﺎء‬ ‫اﻟﺪم‬ ‫ﻛﺮﯾﺎت‬ ‫ﻋﺪد‬ ‫وﻛﺎﻧﺖ‬ 52 ‫ﺑﻨﺴﺒﺔ‬ ‫اي‬ ‫ﻣﺮﯾﺾ‬ % 980. 50. ‫ﻓﻲ‬ 198 ‫ﺑﻨﺴﺒﺔ‬ ‫اي‬ ‫ﻣﺮﯾﺾ‬ % 673. 33 ‫اﻟﺴﻮﻧﺎر‬ ‫ﻓﺤﺺ‬ ‫ﻛﺎن‬ ‫ﺳﺎﻟﺐ‬. ‫وﻣﻦ‬ 198 ‫ﻛﺎن‬ ‫ﻣﺮﯾﺾ‬ 89 ‫ﺑﻨﺴﺒﺔ‬ ‫اي‬ ‫ﻣﺮﯾﺾ‬ % 949. 44 ‫اﻟﻨﺴﯿﺠﻲ‬ ‫اﻟﻔﺤﺺ‬ ‫ﻧﺘﯿﺠﺔ‬ ‫ﻛﺎﻧﺖ‬ ‫ﻣﻮﺟﺒﺔ‬. ‫و‬ 390 ‫ﺑﻨﺴﺒﺔ‬ ‫اي‬ ‫ﻣﺮﯾﺾ‬ % 326. 66 ‫ل‬ ‫اﻟﻨﺴﯿﺠﻲ‬ ‫واﻟﻔﺤﺺ‬ ‫ﻣﻮﺟﺐ‬ ‫اﻟﺴﻮﻧﺎر‬ ‫ﻓﺤﺺ‬ ‫ﻛﺎن‬ 45 ‫ﺑﻨﺴﺒﺔ‬ ‫اي‬ ‫ﻣﻨﮭﻢ‬ ‫ﻣﺮﯾﺾ‬ % 538. 11 ‫ﺳﺎﻟﺐ‬. Abstract Background:Appendicectomy is still the most common surgical procedure; but diagnostic failure may still occur & leads to delay in treatment or negative appendicectomy. Objectives of this study:to evaluate value of preoperative white blood cells count &ultrasonography in diagnosis of acute appendicitis Patients and methods:This study had been carried on 588 cases of acute appendicitis. Appendicectomy done for all cases. Over period of 4 years from January 2006-january 2010. the range of age was between 7-76 years. *Consultant surgeon Al-yarmouk teaching hospital QMJ VOL.7 No.12 248 Jun With mean age of (41.5 years).and median age 25 years old. 366 males (62.244%) and 222 females (37.755). ultrasonography done for all patients by our radiologists. white blood cells count performed in our lab. Results:Negative appendicectomy rate was 102 patients (17.346%) this rate was 42 patients (11.475%) for male and 60 patients (27.027%) for female patients. positive appendicitis in 486 Increase white blood cells count for acute appendicitis (histological positive result) in 388 patients (79.835%) from the 486 patients. And increase white blood cells count for non-acute appendicitis (i.e. negative histological result) in 52 patients (50.980) from the 102 patients. Conclusion:In spite of the improvement tests for acute appendicitis we could not sufficiently reduce the negative appendicectomy rate. If there is doubt about the diagnosis although leukocyte levels and altrasonographic result are normal, especially for female patients performing further radiologic examination such as CT can be favorable.
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