Öz
Amaç: Çalışmanın amacı acil servise sağ alt kadran ağrısı ile gelen kadın hastalarda sağ alt kadran kaynaklı akut apandisit ve over kist rüptrünün ayrıcı tanısında laboratuvar parametreleri tanı koymadaki gücünü analiz etmek
Metod: 2016-2021 yılları arası akut, sağ alt kadran ağrısı ile acil servise başvuran, çekilen abdominal tomografi ve post-operatif patoloji sonuçları ile akut apandisit veya over kist rüptürü tanısı konulan 200 kadın hasta çalışmaya alındı. Hastaların laboratuvar parametreleri analiz edildi. Elde edilen sonuçların ayırıcı tanıdaki rolü araştırıldı.
Bulgular: Çalışmaya alınan kadın hastalar için akut apandisit ve over kist rüptrü tanıları 1:1 randomize edildi. Gruplar, demografik özellikler benzer olacak şekilde modellendi. Hastaların inflamasyonu gösteren parametreleri nötrofil, lenfosit, lökosit, mpv, platelet, crp değerleri analiz edildi. Nötrofil/lenfosit ve platelet/lenfosit oranları hesaplandı. Akut apandisit olan hastalarda inflamasyona ait parametreler, N/L veP/L oranları anlamlı yüksek bulundu. Laboratuvar verileri ile gösterilen yüksek inflamasyon bulguları akut apandisiti desteklemektedir.
Tartışma: Akut apandisit tanılı hastalarda daha güçlü bir inflamatuar reaksiyon görülmektedir. Yüksek inflamatuar markırlar apandisit lehine yorumlanır. Acil servise, sağ alt kadran ağrısı ile gelen kadın hastaların ayırıcı tanısında laboratuvar parametreleri klinik karar vermeyi kolaylaştırır ve ön tanıyı destekler.
Anahtar Kelimeler
Kaynakça
- 1. Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 2020;15:27-33.
- 2. Cervellin G, Mora R, Ticinesi A, et al. Epidemio-logy and outcomes of acute abdominal pain in a large urban Emergency Department: retros-pective analysis of 5,340 cases. Ann Transl Med. 2016;4:362.
- 3. Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. British J Surg 2004;91(1):28-37.
- 4. Flum DR, Koepsell TD. Evaluating diagnostic accuracy in appendicitis using administrative data. J Surg Res 2005;123:257-261.
- 5. Pegoli W. Acute appendicitis. In: Cameron JL (ed). Current surgical therapy. 6th Edition. St Louis: Mosby, 1998. Pp:263-266.
- 6. Colson M, Skinner KA, Dunnington G. High negative appendectomy rates are no longer ac-ceptable. Am J Surg 1997;174:723-726; discus-sion 726-727.
- 7. Fingerhut A, Yahchouchy-Chouillard E, Etienne JC, Ghiles E. Appendicitis or non-specific pain in the right iliac fossa? Rev Prat 2001;51:1654-1656.
- 8. Hallan S, Asberg A, Edna TH. Additional value of biochemical tests in suspected acute appen-dicitis. Eur J Surg 1997;163:533-538.
- 9. Eriksson S, Granstrom L, Olander B, Wretlind B. Sensitivity of interleukin-6 and C-reactive pro-tein concentrations in the diagnosis of acute appendicitis. Eur J Surg 1995;161:41-45.
- 10. Gronroos JM, Gronroos P. Leucocyte count and C-reactive protein in the diagnosis of acute ap-pendicitis. Br. J. Surg. 1999;86:501-504.
- 11. Hallan S, Asberg A, Edna TH. Additional value of biochemical tests in suspected acute appen-dicitis. Eur J Surg 1997; 63:533-538.
- 12. Akbulut S, Arslan M. Akut apandisit nedeni ile opere edilen hastalarda bilgisayarlı tomografi ve laboratuvar değerlerinin analizi. Pamukkale Tıp Dergisi, 2021;14 (3):626-631.
- 13. Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Laboratory tests in patients with acute appendicitis. ANZ journal of surgery, 2006;76(1‐2), 71-74.
- 14. Di Saverio S, Birindelli A, Kelly MD, et al. WSES Jerusalem guidelines for diagnosis and treat-ment of acute appendicitis. World J Emerg Surg 2016;11:34.
- 15. Mengücük ME, Ayten R, Bülbüller N, Gö-dekmerdan A, Başbuğ M, Mungan İ. Akut apandisit tanısında serum C-reaktif protein, prokalsitonin ve neopterinin yeri. Fırat Tıp Der-gisi, 2010;15(1):40-43.
- 16. Hallan S, Asberg A. The accuracy of C-reactive protein in diagnosing acute appendicitis—a me-ta-analysis. Scand. J. Clin. Lab. Invest. 1997;57:373-380.
- 17. Nemoto Y, Ishihara K, Sekiya T, Konishi H, Araki T. Ultrasonographic and clinical appea-rance of hemorrhagic ovarian cyst diagnosed by transvaginal scan. J Nippon Med Sch 2003;70: 243-249.
- 18. LeMaire WJ. Mechanism of mammalian ovula-tion. Steroids 1989;54:455-469.
- 19. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency de-partment evaluation of abdominal pain. Emerg Med Clin North Am 2003; 21: 61-72.
- 20. Ercan Ö, Köstü B, Bakacak M, Coşkun B, Tohma A, Mavigök E. Adneksiyal torsiyon ta-nısında nötrofil/lenfosit oranı. Int J Clin Exp Med. 2015;8:16095-100.
- 21. Shiota, M., Kotani, Y., Umemoto, M., Tobiume, T., & Hoshiai, H. Preoperative differentiation between tumor‐related ovarian torsion and rup-ture of ovarian cyst preoperatively diagnosed as benign: A retrospective study. Journal of Obstet-rics and Gynaecology Research, 2012;39(1):326-329.
- 22. Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: na-tionwide analysis. Arch Surg 2002;137:799-804.
Use of laboratory parameters in the differential diagnosis of ovarian cyst rupture and acute appendicitis
Öz
The study aimed to analyze the diagnostic power of laboratory parameters in the differential diagnosis of acute appendicitis and ovarian cyst rupture originating from the right lower quadrant in female patients presenting to the emergency department with right lower quadrant pain.
Between 2016 and 2021, 200 female patients who presented to the emergency department with acute right lower quadrant pain and were diagnosed with acute appendicitis or ovarian cyst rupture by abdominal tomography and post-operative pathology results were included in the study. Laboratory parameters of the patients were analyzed. The role of the obtained results in the differential diagnosis was investigated.
The diagnoses of acute appendicitis and ovarian cyst rupture were randomized 1:1 for the female patients included in the study. The groups were modeled to have similar demographic characteristics. Neutrophil, lymphocyte, leukocyte, leukocyte, MPV, platelet, and CRP values were analyzed. Neutrophil/lymphocyte and platelet/lymphocyte ratios were calculated. Inflammation parameters, N/L, and P/L ratios were significantly higher in patients with acute appendicitis. High inflammation findings shown by laboratory data support acute appendicitis.
Patients with acute appendicitis have a stronger inflammatory reaction. High inflammatory markers are interpreted in favor of appendicitis. Laboratory parameters facilitate clinical decision-making and support the preliminary diagnosis in the differential diagnosis of female patients presenting to the emergency department with right lower quadrant pain.
Anahtar Kelimeler
Kaynakça
- 1. Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 2020;15:27-33.
- 2. Cervellin G, Mora R, Ticinesi A, et al. Epidemio-logy and outcomes of acute abdominal pain in a large urban Emergency Department: retros-pective analysis of 5,340 cases. Ann Transl Med. 2016;4:362.
- 3. Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. British J Surg 2004;91(1):28-37.
- 4. Flum DR, Koepsell TD. Evaluating diagnostic accuracy in appendicitis using administrative data. J Surg Res 2005;123:257-261.
- 5. Pegoli W. Acute appendicitis. In: Cameron JL (ed). Current surgical therapy. 6th Edition. St Louis: Mosby, 1998. Pp:263-266.
- 6. Colson M, Skinner KA, Dunnington G. High negative appendectomy rates are no longer ac-ceptable. Am J Surg 1997;174:723-726; discus-sion 726-727.
- 7. Fingerhut A, Yahchouchy-Chouillard E, Etienne JC, Ghiles E. Appendicitis or non-specific pain in the right iliac fossa? Rev Prat 2001;51:1654-1656.
- 8. Hallan S, Asberg A, Edna TH. Additional value of biochemical tests in suspected acute appen-dicitis. Eur J Surg 1997;163:533-538.
- 9. Eriksson S, Granstrom L, Olander B, Wretlind B. Sensitivity of interleukin-6 and C-reactive pro-tein concentrations in the diagnosis of acute appendicitis. Eur J Surg 1995;161:41-45.
- 10. Gronroos JM, Gronroos P. Leucocyte count and C-reactive protein in the diagnosis of acute ap-pendicitis. Br. J. Surg. 1999;86:501-504.
- 11. Hallan S, Asberg A, Edna TH. Additional value of biochemical tests in suspected acute appen-dicitis. Eur J Surg 1997; 63:533-538.
- 12. Akbulut S, Arslan M. Akut apandisit nedeni ile opere edilen hastalarda bilgisayarlı tomografi ve laboratuvar değerlerinin analizi. Pamukkale Tıp Dergisi, 2021;14 (3):626-631.
- 13. Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Laboratory tests in patients with acute appendicitis. ANZ journal of surgery, 2006;76(1‐2), 71-74.
- 14. Di Saverio S, Birindelli A, Kelly MD, et al. WSES Jerusalem guidelines for diagnosis and treat-ment of acute appendicitis. World J Emerg Surg 2016;11:34.
- 15. Mengücük ME, Ayten R, Bülbüller N, Gö-dekmerdan A, Başbuğ M, Mungan İ. Akut apandisit tanısında serum C-reaktif protein, prokalsitonin ve neopterinin yeri. Fırat Tıp Der-gisi, 2010;15(1):40-43.
- 16. Hallan S, Asberg A. The accuracy of C-reactive protein in diagnosing acute appendicitis—a me-ta-analysis. Scand. J. Clin. Lab. Invest. 1997;57:373-380.
- 17. Nemoto Y, Ishihara K, Sekiya T, Konishi H, Araki T. Ultrasonographic and clinical appea-rance of hemorrhagic ovarian cyst diagnosed by transvaginal scan. J Nippon Med Sch 2003;70: 243-249.
- 18. LeMaire WJ. Mechanism of mammalian ovula-tion. Steroids 1989;54:455-469.
- 19. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency de-partment evaluation of abdominal pain. Emerg Med Clin North Am 2003; 21: 61-72.
- 20. Ercan Ö, Köstü B, Bakacak M, Coşkun B, Tohma A, Mavigök E. Adneksiyal torsiyon ta-nısında nötrofil/lenfosit oranı. Int J Clin Exp Med. 2015;8:16095-100.
- 21. Shiota, M., Kotani, Y., Umemoto, M., Tobiume, T., & Hoshiai, H. Preoperative differentiation between tumor‐related ovarian torsion and rup-ture of ovarian cyst preoperatively diagnosed as benign: A retrospective study. Journal of Obstet-rics and Gynaecology Research, 2012;39(1):326-329.
- 22. Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: na-tionwide analysis. Arch Surg 2002;137:799-804.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Genel Cerrahi, Cerrahi (Diğer) |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 8 Ağustos 2023 |
| Gönderilme Tarihi | 6 Temmuz 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 16 Sayı: 2 |
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