White blood cell (WBC) as a diagnostic parameter in acute appendicitis in pediatric patients - A retrospective study

Background: Diagnosis of acute appendicitis is challenging particularly in pediatric age group even in the hands of experienced surgeons. Acute appendicitis can be atypically presented in children with non specific abdominal symptoms. In addition, there is increased incidence of perforation within pediatric age group of about 20-50%. Hence, finding cheap, quick and reliable investigatory tool is mandatory. White blood cell count (WBC) is elevated in an inflammatory conditions including appendicitis. Therefore it can be used to support the clinical diagnosis of acute appendicitis. Therefore Gronroos, et al. suggested that we can totally avoid 25% 0f negative appendicitis by measuring WBC level in patient clinically suspected appendicitis. Material and methods: The present study was conducted in 50 pediatric age patients at the hospital who have been clinically diagnosed by surgeons as having acute appendicitis and posted for emergency appendicectomy. Pre-operatively blood was sent for WBC estimation, after operation all specimen were sent for histopathological examination (HPE), results of WBC were correlated with HPE reports to evaluate their role in diagnosis of acute appendicitis. Results: In present study, WBC has highest sensitivity and specificity of 90% and 85% with positive predictive value of 90%. Hence, it has proved that WBC level can be used to rule out negative appendicitis, so that surgery can be deferred in them and to reduce the rate of negative appendicectomies. Conclusion: WBC can support the clinical diagnosis of acute appendicitis especially in pediatric age in reducing the negative appendicectomy rate drastically. Hence it is recommended to get WBC level done in all pediatric age patients with suspected appendicitis.