Shift To The Left; An Indicator of Progression to Perforation in Acute Appendicitis

Background: Appendicitis is a surgical emergency and surgery is crucial for patients diagnosed with having acute appendicitis as any delay in surgery leads to perforation of the organ
Methods: 50 Patients with provisional diagnosis of acute appendicitis were included in the study. Pre-operative blood sample was analysed for neutrophil percentage. The patients were divided into two groups, each comprising of 25 patients on the basis of neutrophil percentage i.e. group A having neutrophils ≥ 75% and group B having neutrophils ≤ 75%. Patients were then followed-up and per-operative findings and histopathology reports were noted for differentiating between perforated and inflamed appendices. SPSS version 22.0 was used for analysis and Pearson’s Chi square test was applied at 5% level of significance. Relative risks along with 95% confidence intervals were also calculated.
Results: 15/25 (60%) patients in Group A developed perforation of appendix when compared to only 1/25 (4%) patient in Group B, who later developed perforation (Relative risk = 15.0, 95% confidence interval=2.1408 to 105.10, P value=0.00). No statistically significant association was observed between age and gender with perforation of appendix.
Conclusion: There is a highly significant statistical association of shift to the left of neutrophils with perforation of appendix.