Acute Appendicitis With Normal Total WBC Counts, a Single Centre Experience.

Abstract

Background: Acute appendicitis is the most common general surgery emergency. Prompt diagnosis minimizes morbidity and mortality. Historically the diagnosis would be clinical. One of the most frequently used laboratory investigation especially in developing regions is the WBC count. Although the total WBC count is elevated in the majority of the patients, normal total WBC count does not rule out acute appendicitis. Materials and methods: A prospective study of patients who underwent emergency appendectomy at our hospital for suspected acute appendicitis between January 2018 and December 2018 was carried out. Patients were studied with respect to preoperative complaints, clinical examination findings, laboratory and imaging results. Patients were specifically analyzed with respect to total and differential WBC counts. Patients with histopathologically confirmed appendicitis were divided into two groups, one with normal and the other with elevated total WBC counts. Results were analyzed and statistical significance determined. Results: A total of 386 patients underwent an emergency appendectomy for presumed appendicitis between January 2018 and December 2018. 377 patients were found to have acute appendicitis, simple or complicated on exploration, subsequently verified on histopathology. The total WBC count was found to be normal in 55 patients (14.58%) as compared to elevated total WBC counts found in 322 patients (85.41%). Polymorphonuclear leucocytes were more than 75% in 52 of the patients (94.54 %) with normal total WBC counts. The same was found in 306 (95.03 %) patients with elevated total WBC counts. Conclusion: A normal total WBC count does not rule out the diagnosis of acute appendicitis straightaway. The differential WBC count seems to be a more important predictor of acute appendicitis than the total WBC count alone.