J Korean Soc Emerg Med.  2019 Aug;30(4):355-359. 10.0000/jksem.2019.30.4.355.

Comparative analysis of unperforated and perforated appendicitis in laboratory values of patients who visited emergency center

• Cho D
• Seo JY

• KMID: 2457228
• DOI: http://doi.org/10.0000/jksem.2019.30.4.355

Abstract

OBJECTIVE
Unperforated and perforated acute appendicitis need to be differentiated because appendicitis with a free perforation requires an emergency operation to prevent contamination inside the bowel from spreading into the peritoneal cavity. The sensitivity of imaging tests is not reliable enough alone for determining the existence of a perforation. The aim of this study was to determine the differences in laboratory values between unperforated and perforated acute appendicitis to help distinguish perforated acute appendicitis.
METHODS
The laboratory values and demographic data of a total of 175 patients who visited the emergency room and were diagnosed with acute appendicitis were collected. The time elapsed from symptom presentation to the ER visit, length of admission, patient demographics, and laboratory values, including sex, age, leukocyte count, neutrophil %, neutrophil count, C-reactive protein (CRP), platelet count, prothrombin time (PT), activated partial thromboplastin time, international normalized ratio (INR), serum glucose, blood urea nitrogen, creatinine, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase were analyzed.
RESULTS
The factors associated with appendix perforations were an elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose and total bilirubin; and delayed PT and INR.
CONCLUSION
Acute appendicitis patients without definite imaging evidence of the perforation but with the laboratory values suggesting a perforation, such as elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose, and total bilirubin; and delayed PT, and INR should raise concern for a possible undiscovered perforation.

Keyword

Acute abdomen; Appendicitis; Differential diagnosis

MeSH Terms

Abdomen, Acute
Alanine Transaminase
Alkaline Phosphatase
Appendicitis*
Appendix
Aspartate Aminotransferases
Bilirubin
Blood Glucose
Blood Urea Nitrogen
C-Reactive Protein
Creatinine
Demography
Diagnosis, Differential
Emergencies*
Emergency Service, Hospital
gamma-Glutamyltransferase
Humans
International Normalized Ratio
Leukocyte Count
Neutrophils
Partial Thromboplastin Time
Patient Admission
Peritoneal Cavity
Platelet Count
Prothrombin Time
Alanine Transaminase
Alkaline Phosphatase
Aspartate Aminotransferases
Bilirubin
C-Reactive Protein
Creatinine
gamma-Glutamyltransferase