2005, Number 6
<< Back Next >>
Cir Cir 2005; 73 (6)
Acute intestinal ischemia serum markers for the diagnosis of acute appendicitis
Menéndez-Arzac R, Cárdenas-Lailson E, Sanjuán-Martínez CA, Rebolledo-López G, Parraguirre-Martínez S, León L, Mata-Miranda MP
Language: Spanish
References: 14
Page: 449-452
PDF size: 108.26 Kb.
ABSTRACT
Introduction: Acute appendicitis is the most common surgical emergency of the abdomen, but is still misdiagnosed in a large number of cases because of the poor accuracy of the different radiologic and laboratory exams. Like in intestinal ischemia, an ischemic factor causes necrosis of the appendiceal wall and this favors the release of particular biochemical serum markers.
Objective: To evaluate the efficacy of intestinal ischemia serum markers as a diagnosis test for acute appendicitis.
Material and methods: Two hundred patients were studied prospectively. Depending on results of the examination by a surgeon, patients underwent surgery for acute appendicitis. Serum levels of amylase, lactic dehydrogenase, alkaline phosphatase, alanine transaminase, aspartate transaminase and leucocyte count were taken preoperatively. We then compared the results with histopathologic findings.
Results: Appendicitis was confirmed in 176 patients. Leukocytes had the highest sensitivity but very low specificity. Amylase and DHL were very specific but their sensitivity was poor. Differential leukocyte count had the highest positive predictive value.
Conclusions: Serum enzymes of intestinal ischemia are not useful markers for the diagnosis of acute appendicitis. Leukocyte count is still the most useful serum marker of appendicitis.
REFERENCES
Schumpelick V, Dreuw B, Ophoff K, et al. Appendix and cecum: embryology, anatomy, and surgical applications. Surg Clin North Am 2000;80:295-318.
2. Rodríguez-Sanjuán JC, Martín-Parra JI, Seco I, et al. C-reactive protein and leukocyte count in the diagnosis of acute appendicitis in children. Dis Colon Rectum 1999;42:1325-1329.
3. Grönroos M, Grönroos P. Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg 1999;86:501-504.
4. Yoon D, Chu J, Chandler C, et al. Human cytokine levels in nonper-
forated versus perforated appendicitis: molecular serum markers for extent of disease? Am Surg 2002;68:1033-1037.
5. Tompson J, Bragg L, West W. Serum enzyme levels during intestinal ischemia. Ann Surg 1990;211:369-372.
6. McKinsey JF, Gewertz BL. Acute mesenteric ischemia. Surg Clin North Am 1997;77:307-318.
7. Murray MJ, Gonze MD, Nowak LR, et al. Serum D(-)-lactate levels as an aid to diagnosing acute intestinal ischemia. Am J Surg 1994;167: 575-577.
8. Feretis CB, Koborozos BA, Vyssoulis GP, et al. Serum phosphate levels in acute bowel ischemia. Am Surg 1985;51:242-244.
9. Gurleyik E, Gurleyik G, Unalmiser S. Accuracy of serum C-reactive protein measurements in diagnosis of acute apendicitis compared with surgeons’s clinical impression. Dis Colon Rectum 1995;38:1270-1273.
10. Albu E, Miller B, Choi Y, et al. Diagnostic value of C-reactive protein in acute appendicitis. Dis Colon Rectum 1994;37:49-51.
11. Kalra U, Chitkara N, Dadoo RC, et al. Evaluation of plasma serotonin concentration in acute appendicitis. Indian J Gastroenterol 1997; 16:18-19.
12. Eriksson S, Granström L, Olander B, et al. Leucocyte elastase as a marker in the diagnosis of acute appendicitis. Eur J Surg 1995;161: 901-905.
13. Paajanen H, Mansikka A, Laato M, et al. Novel serum inflammatory markers in acute appendicitis. Scand J Clin Lab Invest 2002; 62:579-584.
Full text