Acute Appendicit: Is it Possible to Decrease Negative Laparotomy Rate with Serum CRP Measurements?

Abstract

The diagnosis of acute appendicitis is based primarily on the patients history and the clinical symptoms and signs. After clinical diagnosis negative laparotomy rate is still 10-20%. In this study we aimed to determine the accuracy of serum C-reactive protein(CRP) measurement for diminishing the negative laparotomy rate In patients with acute appendicitis. Between-February-July 1994 appendectomy was performed on 108' cases in surgical emergency unit. Serum CRP value was determined preoperatively in all cases. Patients were divided to three groups according to the operative findings and to the results of histopathologic examination:Negative laparotomy (appendix vermiformis-18 cases), nonperforated acute appendicitis (62 cases) and perforated appendicitis (28 cases). Our negative laparotomy rate is 17%. In negative laparotomy group, 10(56%) of the patients are women and average age is 23.5. Serum CRP value is normal in 16 patients and slightly elevated in 2 patients of the negative laparotomy group. 42(68%) of the patients with nonperforated appendicitis are men and average age is 22.9. Mean CRP value is 33.8 mglL(p<10^-6) and CRP value is elevated in 59(%95) of the patients with nonperforated appendicitis. 28(26%) of the patients have perforated appendicitis at laparotomy. 18(64%) of these patients are men and average age is 21.3 in this group. Mean CRP value of perforated appendicitis group is 128.5 mg/L(p<10^-6). Serum CRP value is elevated in 97% of all acute appendicitis cases. In the diagnosis of acute appendicitis CRP sensitivity is 93.5%, specifity 80% and accuracy 91%. We concluded that CRP measurement is useful for decreasing the negative laparotomy rate in atypical and suspicious cases.