ALTERED ALVARADO SCORE; ROLE OF CAECAL GURGLING AS A NEW SIGN IN DIAGNOSIS OF ACUTE APPENDICITIS

Abstract

Background: Diagnosis of acute appendicitis is mainly clinical and many scoring systems are being used. Objectives: To assess the reliability of caecal gurgling as a clinical sign in the diagnosis of acute appendicitis in equivocal cases with Alvarado score of 5–6.

Patients and Methods: This descriptive study was conducted in the Department of General Surgery Unit I, Sheikh Zayed Medical College & Hospital, Rahim Yar Khan, from 1st September 2009 to 31st September 2012. All the patients were presented in OPD & emergency department with history of pain in right lower abdomen of short duration and had no co-morbid condition. We divided the patients into three groups on the basis of Alvarado score. Group I with score 1–4, Group II with score 5–6, and Group III with score 7 or above. Group II was further subdivided into Group IIa having no caecal gurgling and Group IIb having caecal gurgling on clinical examination. We calculated the rate of negative appendectomies on histopathology in different groups. Data were entered and analyzed in SPSS version 15.

Results: A total of 840 patients were included in the study with age ranging from 12–60 years, of which 67% were male. 185 patients fell in Group I, 180 of which were managed conservatively on oral medicine without admission. In Group I only 5 patients needed to be operated and found appendicitis on histopathology. Group II included 286 patients, which was further subdivided into Group IIa (172 patients) having no caecal gurgling and Group IIb (114 patients) having caecal gurgling on clinical examination. Out of 172 patients of Group IIa, 30 appendicectomies were found on histopathology. While all 114 patients of Group IIb were operated and 24 negative appendicectomies were found on histopathology. In Group III, 369 patients were recruited, all were operated and only 13 appendicectomies were proved normal on histopathology report. So with the addition of caecal gurgling, in Group II with equivocal cases having Alvarado score 5–6, there is decrease in rate of negative appendicectomies from nearly 17% reported in literature to 10.8%.

Conclusion: Appendicitis is the common surgical emergency and diagnosis is mainly clinical. Delay in treatment increases morbidity. Altered Alvarado scoring, with addition of caecal gurgling as a clinical sign, is slightly more reliable as compared to the conventional Alvarado scoring system especially in equivocal cases.