engleski

Reliability of gynaecological examination in differential diagnosis of appendicitis in women of reproductive age

The aim of the study was to examine the differential-diagnostical reliability of gynaecological examination in women of reproductive age who have shown clinical symptoms of acute abdomen in the lower right quadrant, with a dilemma whether this was due to acute appendicitis or acute gynaecological disease. Patients and methods. During the 15- year period (from 1988 to 2003), there were 530 women of reproductive age who underwent surgery for suspected acute appendicitis at County Hospital in Požega. Case histories, intraoperative findings, pathohistological findings, as well as consultative gynaecological findings were analysed retrospectively. For statistical analysis χ2 test was used, with measuring confidence intervals at the level of 95% (p<0.05). Results. Out of 530 women of reproductive age included in the study, 159 of them were referred to a gynaecological examination (group A) and 371 of them were not (group B). In the group A (n=159), 34 (21.4%) women were diagnosed with a gynaecological disease intraoperatively even though the previous palpatory gynaecological findings were normal. In the group B (n=371), 22 (5.9%) patients were diagnosed with a gynaecological disease intraoperatively but these patients were not referred to a gynaecologist at all. Among all the women at 34 was diagnosed an ovarian cyst, at 12 a tubo-ovarian abscess, at 9 a pelvic inflammatory disease and at 1 an ovarian torsion. A significant (p<0.05, χ2=26.516 ; odds ratio=4.31 ; CI 95%=2.43-7.65) unreliability of bimanual gynaecological examination was found in diagnosing an acute gynaecological pathology in female patients who were referred to a consultation by a surgeon. Conclusion. The results of this study suggest a significant unreliability of bimanual gynaecological examination in differential diagnosis of acute abdomen in women of reproductive age. Clinical work should, at any rate, include other diagnostical methods (US ; CT ; laparoscopy, MRI), aiming at a more precise diagnosis, which would then lead to the application of a more adequate therapy.

Algorithm ; Appendicitis ; Differential diagnosis ; Gynaecological examination ; Reproductive age

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