When it's not appendicitis

Area of Science:

• Abdominal Surgery
• Gastroenterology
• Diagnostic Imaging

Background:

• Right lower quadrant (RLQ) pain is a common presentation in emergency settings.
• Appendicitis is the most frequent diagnosis, but other pathologies can mimic its symptoms.
• Routine diagnostic laparoscopy for all RLQ pain cases may increase healthcare costs without proven benefit.

Purpose of the Study:

• To evaluate the incidence of non-appendiceal pathology in patients presenting with RLQ pain.
• To determine if a selective approach to diagnostic laparoscopy is warranted based on patient demographics and suspected pathology.
• To identify patient groups who may benefit most from diagnostic laparoscopy for RLQ pain.

Main Methods:

• Retrospective review of 202 appendectomy cases.
• Analysis of pathology findings stratified by age and sex.
• Calculation of the frequency of non-appendiceal pathology in different subgroups.

Main Results:

• In females under 50, 26% had other non-appendiceal pathology; this was 42% in those with normal appendices and 57% with periappendicitis.
• In males under 50, 5% had other non-appendiceal pathology; this was 50% in those with normal appendices.
• In patients over 50, 20% had other non-appendiceal pathology.

Conclusions:

• Women of childbearing age and patients over 50 years old exhibit a significant incidence of non-appendiceal pathology.
• A selective diagnostic laparoscopy approach is justified in these specific patient groups presenting with RLQ pain.
• This approach can aid in accurate diagnosis and potentially optimize treatment strategies for RLQ abdominal pain.