Ghazia Shahid, Harun Majeed Dar, Haroon Javaid Majid, Zulfiqar Siddique, Shahid Mehmood, Muhammad Tufail.
A study of gynaecological emergencies presenting as Acute Appendicitis.
Proceeding Shaikh Zayed Postgrad Med Inst Jan ;19(1):13-7.

Objectives: To assess the frequency of gynaecological emergencies presenting as acute appendicitis among females of child bearing age. Design: Descriptive analytical study. Place and duration of study: The study was conducted at the surgical unit-II of Sheikh Zayed hospital and postgraduate medical institute Lahore from January 2000 to December 2000. Patients and Methods: The study included 105 female patients aged 15-45 presented in accident and emergency department with right iliac fossa pain. Diagnosis was clinical in all cases .Investigations for leukocyte count, pregnancy test and lower abdominal ultrasound scan were used to improve diagnostic accuracy. All diagnosed patients underwent appendectomy and intra-operative findings were recorded. Patients with gynaecological disorder were dealt accordingly. Final diagnosis of acute appendicitis was made on Intra-operative findings and histopathology report. Results: There was high frequency of gynaecological disorders simulating acute appendicitis in the age group ranging 15-25 years with mean age 23.1 and standard deviation + 0.74. Duration of pain ranges from 12 hours to 4 days. Pain and tenderness in right iliac fossa was found in all patients where as shifting of pain was present in 61% of cases. Total leukocyte count more than 11000 per cubic millimeter was present in 60% cases. Peroperatively acutely inflamed appendix was found in 71.4% ruptured ovarian cyst in 11.4%, right tubal abortion in 0.9% and pelvic inflammatory disease in 4.7% of patients. Histopathological report revealed that in 77.1% of cases appendix was acutely inflamed. Thus out of 105 study subjects who underwent appendectomy, 18(17%) were having gynaecological problems. In 3(2.8%) mesenteric lymph node biopsy was done , which turned out to be chronic nonspecific inflammation . in 9(8.5%) no positive finding could be found preoperatively . The rate of negative appendectomy in our study was 22.9%. Conclusion: There is considerable number of young females with gynaecological disorders presen ting in emergency as acute appendicitis. Good clinical judgment and routine use of ultrasonography is desirable to reduce the negative rate.

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