Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1393
Peer-review started: March 13, 2019
First decision: March 19, 2019
Revised: April 13, 2019
Accepted: May 10, 2019
Article in press: May 11, 2019
Published online: June 26, 2019
Because of the high prevalence of right colonic diverticulosis in Asian countries, acute right colonic diverticulitis (ARCD) is an important differential diagnosis of acute appendicitis (AA) in Asian countries. However, studies on the clinical differentiation of AA and ARCD are limited.
Given the cost, limited availability in primary care settings and concern for radiation exposure in young patients of computed tomography (CT) scan, evidence on the clinical differentiation of ARCD and AA based on history, physical signs, and easily available laboratory data will be useful for clinicians who care for Asian patients with acute abdomen.
This study aimed to reveal clinical findings, such as symptoms, physical signs, and widely available laboratory data that are useful for differentiating AA from ARCD.
We performed a single-center retrospective case-control study that evaluated 236 patients with AA and 133 patients with ARCD, who were hospitalized in Toho University Medical Center Omori Hospital between 2012 and 2016. We compared patients’ characteristics, symptoms, physical signs, and widely available laboratory data. We performed logistic regression for clinical differentiation between AA and ARCD.
Median ages were 35.5 and 41.0 years in the AA and ARCD groups, respectively (P = 0.011). Median onset-to-visit intervals were 1 and 2 days in the AA and ARCD groups, respectively (P < 0.001). Prevalences of epigastric/periumbilical pain, nausea/vomiting, anorexia, and history of unresected appendicitis were significantly higher in the AA group, whereas RLQ pain and history of diverticulitis were more prevalent in the ARCD group. Median leukocyte counts in the AA and ARCD groups were 12600 and 11500/mm3, respectively (P = 0.002). Median CRP levels in the AA and ARCD groups were 1.1 and 4.9 mg/dL, respectively (P < 0.001). The logistic regression model showed a significantly high odds ratio (OR) in nausea/vomiting (OR: 3.89) and anorexia (OR: 2.13). ORs were significantly lower with a longer onset-to-visit interval (OR: 0.84), RLQ pain (OR: 0.28), history of diverticulitis (OR: 0.034), and CRP level > 3.0 mg/dL (OR: 0.25), suggesting that ARCD was more likely.
Our logistic regression model for differentiating AA from ARCD showed that nausea/vomiting and anorexia increase the probability of AA rather than ARCD. Conversely, longer onset-to-visit interval, RLQ pain, history of diverticulitis, and CRP level > 3.0 mg/dL at the time of visit increase the probability of ARCD rather than AA. Our study suggests that clinical findings can differentiate AA and ARCD based on clinical information in advance of imaging studies.
Given the lack of previous study on clinical differences between AA and ARCD, and the cost, limited availability, and concern for radiation exposure of CT scanning, our findings will provide useful evidence for physicians managing Asian patients with acute abdomen.