Is neutrophilia the key to diagnosing appendicitis in pregnancy?
J Quinn Gentles1, Gabriela Meglei2, Leo Chen1
1Department of Surgery, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
Background:
The diagnosis of acute appendicitis (AA) in pregnancy remains challenging. We investigated which preoperative clinical factors are most predictive of AA in pregnant women.
Methods:
164 pregnant patients undergoing magnetic resonance imaging for suspected AA were retrospectively reviewed. Logistic regression was used to compare those with pathologically confirmed AA and those without.
Results:
28 patients (17.1%) had pathologically confirmed AA. 42.9% (n = 12) were perforated at the time of operation. Factors associated with AA included history of emesis (p = 0.005), migratory abdominal pain (p = 0.006), rebound tenderness (p = 0.01), elevated white blood cell count (p = 0.003), elevated Alvarado Score (p < 0.001), elevated neutrophil count (p = 0.021), and left shift (p = 0.001). As a screening test, a left shift with neutrophils >70% provided a sensitivity and negative predictive value of 100.0%.
Discussion:
Every patient in our series with AA had a left shift. Neutrophil count and percentage should be considered in the diagnostic evaluation of these patients to better guide resource utilization and treatment.
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