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

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    Authors
    McCartan, D P
    Fleming, F J
    Grace, P A
    Affiliation
    Department of Surgery, Mid-Western Regional Hospital, University of Limerick,, Limerick, Ireland.
    Issue Date
    2012-01-31T16:47:29Z
    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
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    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
    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
    ISSN
    1479-666X (Print)
    1479-666X (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.surge.2009.11.008
    Scopus Count
    Collections
    University Hospitals Limerick

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