Abstract
Background: The diagnosis of acute appendicitis is challenging specially in the pediatric population, due to potential atypical clinical presentations. Despite the available multiple modern diagnostic tools the diagnosis of acute appendicitis is still primarily done by taking into account history and physical findings and raised differential count. In this study we have compared the diagnostic value of various elements of the disease history and clinical findings and differential counts in patients with suspected appendicitis.
Methodology: In this prospective type of study, a total of 102 patients with clinical diagnosis of acute appendicitis were admitted during the study period of one calendar year. On admission, a good clinical history and proper physical examination was performed. All patients were investigated by doing total leucocytes count, differential count, left shift and complete urine examination. All the eligible patients who finally diagnosed clinically as having acute appendicitis were planned for emergency open appendectomy. The removed appendix was sent for histopathological examination (HPE) in all the study subjects. HPE report was made available and was taken as final diagnosis.
Results: A total of 102 patients with clinical diagnosis of acute appendicitis were admitted during the study period and on histopathology there was no evidence of appendicular inflammation in 9 patients. The symptoms of nausea/ vomiting and periumbilical pain migrating to right iliac fossa were found to be good predictors of appendicitis. Among the signs the presence of tenderness at McBurney’s point, guarding in RIF and rebound tenderness were significant predictors of appendicular inflammation. A normal value of total leucocytes count was a good evidence of ruling out the appendicitis. Neutrophils were found to be shifted on left side in majority of the cases of appendicitis.

Key words: acute appendicitis, children, clinical signs.