A Prospective Audit of 300 Consecutive Young Women with an Acute Presentation of Right Iliac Fossa Pain

Abstract

INTRODUCTIONA prospective study of 300 women of child-bearing age presenting with right iliac fossa pain was carried out to determine what proportion had appendicitis and whether active observation resulted in a delay in diagnosis to the detriment of the patient.PATIENTS AND METHODSData were prospectively collected for 300 consecutive women of childbearing age referred with right iliac fossa pain to general surgeons at a district general hospital.RESULTSAfter clinical assessment, 71 were discharged home immediately. Two others were found to be pregnant and 4 admitted to gynaecology. The remaining 223 women were admitted to the general surgical unit, 112 of whom underwent immediate appendicectomy. Of these, 97 had acute appendicitis. Two suffered deep infection and two had a superficial wound infection. A further decision to operate was made in 42 of 111 patients admitted for active observation, with 36 having acute appendicitis and 2 having a carcinoid tumour. Four had a wound infection. The average in-patient stay of those admitted for active observation and not operated on was 2 days (range, 1–4 days) compared with a length of stay of 2 days (range, 1–7 days) for those who underwent ‘immediate’ appendicectomy.CONCLUSIONSMost women of child-bearing age who present with right iliac fossa pain do not have appendicitis. Those who do not have the classical features of appendicitis or peritonism can be safely managed by active observation.