Leucocyte count and oral temperature are a useful guide to selecting women with right iliac fossa pain for diagnostic laparoscopy

INTRODUCTION In women, negative appendicectomy rates can be as high as 34%. A 5-fold reduction is possible with diagnostic laparoscopy. A selective policy is favoured as indiscriminate use may increase postoperative morbidity. Scoring systems are helpful but not used widely du to their complexity. The value of leucocyte count and temperature in selecting women with right iliac fossa pain for diagnostic laparoscopy is investigated. PATIENTS AND METHODS Over a 12-month period, admission leucocyte count and temperature data were obtained from women undergoing appendicectomy. Cohorts were sub-categorised by age (< 20, 21-40 and > 40 years) and the proportion of negative (normal appendix) and positive (inflamed, gangrenous or perforated appendix) appendicectomies compared. RESULTS In 100 women, 11% had leucocyte counts and temperature >= 11 x 10(9)/l and 38 degrees C, respectively; all had appendicitis. In 50%, leucocyte counts and temperature were >= 11 x 10(9)/l and < 38 degrees C; negative appendicectomies occurred in 13.8% < 20 years, 10% > 40 years (P< 0.01) and 27.3% aged 21-40 years (P = 0.086). In 39%, the negative appendicectomy rate was >= 36.8% when leucocyte count and temperature were < 11 x 10(9)/l and 38 degrees C (P = 0.1). CONCLUSION Diagnostic laparoscopy should be considered in all women when leucocyte counts and temperature are >= 11 x 10(9)/l and 38 degrees C and for females aged 21-40 years when these values are >= 11 x 10(9)/l and < 38 degrees C.