Diagnostic laparoscopy in acute right iliac fossa (RIF) pain to take the appendix or to leave it in? (2015)

Type of publication:
Conference abstract

*Sukha A., *Packer H., *Taylor M., *Goodyear S.

Surgical Endoscopy and Other Interventional Techniques, April 2015, vol./is. 29/(S309-S310)

Aims Laparoscopy is used to both investigate acute RIF pain and treat the findings of an inflamed appendix. This study investigates the histology of appendixes where the clinical diagnosis was unclear on presentation and the investigative imaging was inconclusive. Methods Retrospective data collection between January – June 2014 of all appendectomies. Data was collected from Theatre logbooks and the Pathology and PACS computer systems, and analysed in Microsoft Excel. Results 50 patients had an undiagnosed cause of RIF pain. 15% (n = 34) had an USS and 7% (n = 16) had a CT. 58% (n = 29) of scans were reported as negative/inconclusive for appendicitis. All 29 patients had a DL and appendicectomy and 45% (n = 13) were histologically reported as appendicitis. There was 3% (n = 1) associated morbidity and 0% mortality. Conclusion The appendix should be removed when faced with a diagnostic uncertainty and no other pathology is found. The advancement of laparoscopic skills and training has led to low morbidity and mortality as supported by this study. We conclude it is safer to remove the appendix than to leave it in. Key statement The presentation of an acute right iliac fossa pain can sometimes be clinically difficult to diagnose. When investigations are normal or inconclusive and symptoms persist the advancement of laparoscopic surgery allows us to perform diagnostic laparoscopy. When there is no obvious pathology found the appendix should still be removed.