Analytical interpretation referring diagnostic parameters of acute appendicitis among patients applying with abdominal pain

We have conducted a retrospective analysis of the clinical files, regarding 3068 patients consulted by the department of pediatric surgery in this study, amongst 12126 patients who applied with complaints of abdominal pain under the age of 18, in the Health Application and Research Center in Bülent Ecevit University, Zonguldak, Turkey, between January 2012 and May 2020. Out of 1200 patients hospitalized and followed under the diagnosis of acute abdomen, 791 cases were treated surgically. A total of 657 patients diagnosed as acute appendicitis, were evaluated statistically in this study regarding histopathological results, gender and seasonal incidence, physical examination findings, laboratory screening tests and imaging studies. Histopathological analysis of appendectomy specimens revealed lymphoid hyperplasia in 12.3%, acute appendicitis in 60.5%, phlegmonous appendicitis in 12.3%, suppurative appendicitis in 8.3% and further perforated appendicitis in 6.7% of operated cases. There was a significant difference regarding complaints of nausea, vomiting, and defecation along with physical examination findings such as defense and rebound, between two groups of patients that were operated or followed clinically (p<0.001). No statistical significance was found for right lower quadrant tenderness between the two groups (p=0.777). USG screening confirmed appendix diameter above 6 mm in 91%, presence of mesenteric heterogeneity in 91% and finally the presence of an abscess formation in 100%. We confirm that physical examination findings such as loss of appetite, vomiting, constipation, right lower quadrant tenderness, rebound and defense, along with laboratory cut off values as WBC ≥14500/mm3, neutrophil ≥9.6 mcL and lymphocyte count <1.8 µL, neutrophil percentage ≥74%, and neutrophil lymphocyte ratio ≥4.7 will clarify diagnosis. Parameters as appendiceal diameter length, response to compression, appendiceal fluid collection and mesenteric heterogeneity in USG screening will aid as highly predictive tools in diagnosing of acute appendicitis.