Diagnostic dilemma of right iliac fossa pain in females: a prospective study of 100 cases

Abstract

Background: Right iliac fossa (RIF) pain in females presents a significant diagnostic challenge due to the wide range of potential underlying causes. This study aims to elucidate the complexities and diagnostic dilemmas associated with RIF pain in females, focusing on the prevalence of various conditions, the utility of laboratory markers, and the outcomes of surgical interventions. Methods: This prospective study was conducted at Shaheed Tajuddin Ahmed Medical College Hospital, Gazipur, Bangladesh and involved 100 female patients provisionally diagnosed with acute appendicitis. The study included females aged 12 years and above, presenting with symptoms suggestive of acute appendicitis and who were operable. Patients underwent clinical evaluations, laboratory testing, and, where indicated, surgical intervention, including appendectomy. Data were analyzed using SPSSV.19, with findings presented in table format. Results: The most common presenting symptoms were central abdominal pain shifting to RIF, nausea, vomiting, and pyrexia (45%). Laparotomy findings indicated acute suppurative appendicitis in 68% of cases. Appendicectomy results showed a 61% positive diagnosis rate for appendicitis, with 23% negative appendicitis findings. Laboratory results revealed leukocytosis (>11000/mm3) in 66% and a neutrophil count of ≥70% in 71% of the cases. Histopathological analysis post-appendectomy revealed 57.14% acute appendicitis, 15.48% gangrenous appendicitis, and 27.38% normal vermiform appendix. Conclusions: The study highlights the diagnostic challenges in females presenting with RIF pain, with a significant rate of negative appendicitis diagnoses post-appendectomy. The findings underscore the need for a comprehensive diagnostic approach and suggest the potential utility of laboratory markers in supporting diagnoses. The study advocates for improved diagnostic criteria and methods to enhance accuracy and patient outcomes.