Towards an evidence-based management of right iliac fossa pain in the over 50-year-old patient

Introduction Right iliac fossa pain is a common presenting complaint to general surgery. The differential diagnosis is wide, particularly in the elderly. Computed tomography (CT) is often used in the 'older' population, as they have a higher prevalence of acute colonic diverticulitis and c...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2016-09, Vol.98 (7), p.496-499
Main Authors: Gammeri, E, Catton, A, van Duren, B H, Appleton, S G, van Boxel, G I
Format: Article
Language:English
Subjects:
Abdomen
Abdominal Pain - diagnostic imaging
Abdominal Pain - etiology
Age
Aged
Aged, 80 and over
Appendicitis
Arthralgia - etiology
Arthralgia - surgery
Audit departments
Cancer
Collaboration
Colon
Colonic Neoplasms - complications
Colonic Neoplasms - diagnosis
Diverticulitis, Colonic - complications
Diverticulitis, Colonic - diagnosis
Evidence-Based Medicine - methods
Female
Gastrointestinal Surgery
Gynecology
Hip Joint - diagnostic imaging
Hip Joint - surgery
Hospitals
Humans
Ilium - diagnostic imaging
Laparoscopy
Male
Medical imaging
Medical research
Middle Aged
Pain
Patients
Retrospective Studies
Sepsis
Studies
Surgeons
Surgery
Systemic Inflammatory Response Syndrome - etiology
Tomography, X-Ray Computed
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Summary:Introduction Right iliac fossa pain is a common presenting complaint to general surgery. The differential diagnosis is wide, particularly in the elderly. Computed tomography (CT) is often used in the 'older' population, as they have a higher prevalence of acute colonic diverticulitis and colonic neoplasia, both of which should be identified prior to surgery. There is, however, no published evidence to support this practice. Methods We retrospectively reviewed the records of all patients aged over 50 years who presented with right iliac fossa (RIF) pain to a district general hospital. We determined whether tenderness was predominantly right- or left-sided and whether systemic inflammatory response syndrome (SIRS) was present on admission. The use of imaging modalities, their results and, if performed, operative findings were recorded. Results Of 3160 patients identified, 89 met the inclusion criteria. Diagnoses included appendicitis (27%), neoplasia (15%), non-specific abdominal pain (15%) and acute colonic diverticulitis (10%). CT was performed in 82% of patients, with a sensitivity of 97% based on operative findings. Six patients underwent surgery without a scan, two of whom required a change in the planned procedure due to unexpected findings. Conclusions Unless contraindicated, CT scanning should be mandatory in patients aged over 50 years presenting with signs of peritonism in the RIF or lower abdomen.
ISSN:0035-8843
1478-7083
DOI:10.1308/rcsann.2016.0188