The management of right iliac fossa pain - is timing everything?

Hdl Handle:
http://hdl.handle.net/10147/206292
Title:
The management of right iliac fossa pain - is timing everything?
Authors:
McCartan, D P; Fleming, F J; Grace, P A
Affiliation:
Department of Surgery, Mid-Western Regional Hospital, University of Limerick,, Limerick, Ireland.
Citation:
Surgeon. 2010 Aug;8(4):211-7. Epub 2010 Feb 8.
Journal:
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Issue Date:
31-Jan-2012
URI:
http://hdl.handle.net/10147/206292
DOI:
10.1016/j.surge.2009.11.008
PubMed ID:
20569941
Abstract:
BACKGROUND: Right iliac fossa (RIF) pain remains the commonest clinical dilemma encountered by general surgeons. We prospectively audited the management of acute RIF pain, examining the relationship between symptom duration, use of pre-operative radiological imaging and patient outcome. METHODS: Over a six-month period, 302 patients, median age 18 years, 59% female, were admitted with RIF pain. Symptoms, clinical findings and laboratory results were documented. Patient management, timing of radiological investigations and operations, and outcome were recorded prospectively. RESULTS: Non-specific abdominal pain (26%), gynaecological (22%) and miscellaneous causes (14%) accounted for most admissions. Ultimately, 119 patients (39%) had appendicitis. Anorexia, tachycardia or rebound tenderness in the RIF significantly predicted a final diagnosis of appendicitis. Patients with perforated appendicitis (n = 29) had a longer duration of pre-hospital symptoms (median 50h) compared to those with simple appendicitis (median 17 h) (p<0.001). The use of pre-operative imaging resulted in an increased time to surgery but was not associated with increased post-operative morbidity or perforated appendicitis. CONCLUSION: The majority of patients presenting to hospital with RIF pain did not have appendicitis. Increased duration of pre-hospital symptoms was the main factor associated with perforated appendicitis. However, increased in-hospital time to theatre was not associated with perforated appendicitis or post-operative morbidity.
Language:
eng
MeSH:
Abdominal Pain/*diagnosis/*surgery; Acute Disease; Adolescent; Adult; Appendectomy; Appendicitis/*diagnosis/*surgery; Child; Diagnosis, Differential; Female; Genital Diseases, Female/*diagnosis/*surgery; Humans; *Ilium; Intestinal Diseases/*diagnosis/*surgery; Laparoscopy; Logistic Models; Male; Prospective Studies; Statistics, Nonparametric; Treatment Outcome
ISSN:
1479-666X (Print); 1479-666X (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorMcCartan, D Pen_GB
dc.contributor.authorFleming, F Jen_GB
dc.contributor.authorGrace, P Aen_GB
dc.date.accessioned2012-01-31T16:47:29Z-
dc.date.available2012-01-31T16:47:29Z-
dc.date.issued2012-01-31T16:47:29Z-
dc.identifier.citationSurgeon. 2010 Aug;8(4):211-7. Epub 2010 Feb 8.en_GB
dc.identifier.issn1479-666X (Print)en_GB
dc.identifier.issn1479-666X (Linking)en_GB
dc.identifier.pmid20569941en_GB
dc.identifier.doi10.1016/j.surge.2009.11.008en_GB
dc.identifier.urihttp://hdl.handle.net/10147/206292-
dc.description.abstractBACKGROUND: Right iliac fossa (RIF) pain remains the commonest clinical dilemma encountered by general surgeons. We prospectively audited the management of acute RIF pain, examining the relationship between symptom duration, use of pre-operative radiological imaging and patient outcome. METHODS: Over a six-month period, 302 patients, median age 18 years, 59% female, were admitted with RIF pain. Symptoms, clinical findings and laboratory results were documented. Patient management, timing of radiological investigations and operations, and outcome were recorded prospectively. RESULTS: Non-specific abdominal pain (26%), gynaecological (22%) and miscellaneous causes (14%) accounted for most admissions. Ultimately, 119 patients (39%) had appendicitis. Anorexia, tachycardia or rebound tenderness in the RIF significantly predicted a final diagnosis of appendicitis. Patients with perforated appendicitis (n = 29) had a longer duration of pre-hospital symptoms (median 50h) compared to those with simple appendicitis (median 17 h) (p<0.001). The use of pre-operative imaging resulted in an increased time to surgery but was not associated with increased post-operative morbidity or perforated appendicitis. CONCLUSION: The majority of patients presenting to hospital with RIF pain did not have appendicitis. Increased duration of pre-hospital symptoms was the main factor associated with perforated appendicitis. However, increased in-hospital time to theatre was not associated with perforated appendicitis or post-operative morbidity.en_GB
dc.language.isoengen_GB
dc.subject.meshAbdominal Pain/*diagnosis/*surgeryen_GB
dc.subject.meshAcute Diseaseen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdulten_GB
dc.subject.meshAppendectomyen_GB
dc.subject.meshAppendicitis/*diagnosis/*surgeryen_GB
dc.subject.meshChilden_GB
dc.subject.meshDiagnosis, Differentialen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshGenital Diseases, Female/*diagnosis/*surgeryen_GB
dc.subject.meshHumansen_GB
dc.subject.mesh*Iliumen_GB
dc.subject.meshIntestinal Diseases/*diagnosis/*surgeryen_GB
dc.subject.meshLaparoscopyen_GB
dc.subject.meshLogistic Modelsen_GB
dc.subject.meshMaleen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshStatistics, Nonparametricen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleThe management of right iliac fossa pain - is timing everything?en_GB
dc.contributor.departmentDepartment of Surgery, Mid-Western Regional Hospital, University of Limerick,, Limerick, Ireland.en_GB
dc.identifier.journalThe surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Irelanden_GB
dc.description.provinceMunster-

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