RU2434573C2 - Method of diagnosing acute appendicitis of allergic genesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery and allergology. Patient with acute appendicitis undergoes examination. Leukocytic index of intoxication, level of C-reactive proteine, level of IgG and IgE in peripheral blood, level of circulating immune complexes are determined. Allergologic history is found out; disturbance of diet on the eve of disease, earlier occurring pains in abdomen. Detected factors of risk of acute appendicitis development are evaluated in points depending on their presence or absence, as well as numerical values. Obtained points are summed up, and value of index of development of acute appendicitis (IDAA) is determined. If IDAA value is lower than 5 points, low risk of development of acute appendicitis is predicted, and if IDAA value is equal pr higher than 5 points - high risk of development of acute appendicitis of allergic genesis is predicted.

EFFECT: method makes it possible to solve problems of conservative or operative tactics of patient treatment in due time.

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Description

The invention relates to medicine, namely to surgery and allergology, and can be used in clinical practice for the diagnosis of acute appendicitis (OA) of allergic origin.

OA is one of the most common causes of acute abdomen requiring surgical intervention. Diagnosis of OA in typical cases is not difficult. However, it is not always possible to timely and correctly diagnose and promptly establish indications for surgical intervention. In this regard, the diagnosis of OA is an urgent problem of surgery.

The intestinal mucosa is continuously exposed to a huge number of pro-inflammatory and immunogenic stimuli that come from food and normal intestinal microflora. The dynamic balance of the microflora of the gastrointestinal tract (GIT) is supported by various mechanisms, both immune and non-immune. The main role in this is played by intestinal lymphoid tissue. Normally, there is regulation and selectivity of defense mechanisms that ultimately determine the immunological tolerance to indigenous microflora or the immune response to pathogens. Dysbiotic abnormalities can change the phenotype of intestinal lymphoid tissue towards the prevalence of Th2 cells, and also contribute to the development of allergic reactions, autoimmune disorders and inflammatory bowel diseases, in particular the development of acute appendicitis of allergic genesis.

OA treatment tactics involve early appendectomy to avoid the development of perforation of the vermiform appendix (PR), leading to complications and increased mortality. In practice, it is not always possible to use informative diagnostic methods to determine the nature of inflammation. One of these methods is abdominal laparoscopy. Since this method is invasive and expensive, it is not widely used in practice.

A known method for the diagnosis of OA [1], based on laparoscopy of the abdominal organs. The technique allows you to visually diagnose OA at the macroscopic level in the presence of changes in the BH.

The known method is not sufficiently informative, since in some cases with laparoscopy it is not possible to visualize CHO, for example, with its retrocecal and retroperitoneal location, it is also not always possible to correctly interpret the intraoperative picture. Laparoscopy can be difficult in people who have had previous surgery on the abdominal organs. In addition, laparoscopy itself is an surgical intervention and can lead to complications: injuries of hollow organs, bronchospasm, emphysema of the greater omentum and mediastinum, bleeding. In this regard, diagnostic laparoscopy cannot be performed as a screening test in all patients with suspected OA. This reduces the effectiveness of the diagnostic method.

A known method for the diagnosis of OA [2] by applying ultrasound (ultrasound). Ultrasound is a non-invasive research method, which allows it to be used in all patients without exception, as well as to conduct ultrasound in dynamics with an unclear clinical and ultrasound picture of the disease.

The known method is also not sufficiently informative, depending on the experience of the researcher, the quality of the ultrasound apparatus. With this method, the level of false positive and false negative results remains high, which reduces the effectiveness of the diagnostic method.

There is also a method for the diagnosis of OA [3], based on the determination of the lysosomal cationic test.

The known method has high sensitivity, but insufficient specificity, which reduces its effectiveness.

In the literature available to us, no method for diagnosing acute appendicitis of allergic genesis has been found, used to determine indications and contraindications for appendectomy.

The objective of the invention is to develop an informative method for the diagnosis of acute appendicitis of allergic genesis.

The problem is solved by determining the risk factors for the development of acute appendicitis of allergic genesis and assigning points to them. When:

a positive allergic history is assigned 2 points;

violation of the diet on the eve of the disease - 2 points; earlier abdominal pain - 1 point; LII more than 1 and less than 0.5 - 2 points; the level of C-reactive protein more than 5 mg / l - 2 points; peripheral blood IgG level more than 16.6 g / l - 2 points; peripheral blood IgE level of more than 100 IU / ml - 2 points; the level of circulating immune complexes is more than 100 cu - 2 points. The scores are summarized, thereby determining the value of the acute appendicitis risk index (IROA). With an IROA value of less than 5 points, a low risk of developing acute appendicitis of an allergic genesis is predicted, and with an IROA value equal to or more than 5 points, a high risk of developing acute appendicitis of an allergic genesis is predicted.

A threshold value of 5 points was obtained on the basis of a comparison of the IROA values with the clinical signs of OA identified during the examination of patients, as well as with the data of histological studies after appendectomy.

No. Risk factors for acute appendicitis Points one Positive allergic history 2 2 Violation of the diet on the eve of the disease 2 3 Earlier abdominal pain one four Leukocyte intoxication index of more than 1 and less than 0.5 2 5 The level of C-reactive protein is more than 5 mg / l 2 6 The level of IgG in peripheral blood is more than 16.6 g / l 2 7 The level of IgE in peripheral blood is more than 100 IU / ml 2 8 The level of circulating immune complexes is more than 100 cu 2

The method is carried out in the following way.

When examining a patient with a suspicion of OA of allergic genesis, on the basis of the conversation and the data of laboratory research methods, an allergological history, a diet on the eve of the disease, earlier abdominal pain, leukocyte intoxication index (LII), C-reactive protein level, IgG and IgE levels in peripheral blood, the level of circulating immune complexes. The data obtained are compared with the table where the indicators are scored. Calculate the total score, which determines the risk index for the development of acute appendicitis (IROA), which can take values from 0 to 15. A value of IROA less than 5 points indicates a low risk, and a value of IROA equal to or more than 5 points indicates a high risk of developing acute appendicitis allergic genesis. With a value of IROA equal to or more than 5 points, an operative measure is required - appendectomy. In the future, these patients are recommended to conduct a specific allergological examination in order to establish and eliminate causally significant allergens to prevent the development of allergic inflammation in other parts of the gastrointestinal tract, since appendectomy solves the problem only of a local nature.

According to the proposed method, in the surgical department of Federal State Health Institution KB No. 51 of the FMBA of the Russian Federation, Zheleznogorsk, Krasnoyarsk Territory, 34 patients with an aggravated allergic history, aged 8 to 55 years, with a clinically verified diagnosis of acute appendicitis, were examined.

The inventive method can be demonstrated by the following examples:

Clinical example 1. Patient A., 19 years old. Received complaints of pain in the lower abdomen, nausea. Sick for 5 hours. On examination, moderate soreness in the lower abdomen, appendicular symptoms are mild, there are no symptoms of peritoneal irritation. Preliminary diagnosis: intestinal colic? acute appendicitis? A patient was examined according to the proposed method, as a result of which the following data were obtained: positive allergic history - 2 points; violation of the diet on the eve of the disease - 2 points; pain in the abdomen earlier (about 6 months ago, pains in the right iliac region, which stopped on their own, bothered) - 1 point; IgG level 18.45 mg / ml - 2 points; IgE level of 146 IU / ml - 2 points; the level of circulating immune complexes is 115 cu - 2 points. IROA was 11 points. The obtained value of the IROA is included in the interval "equal to or greater than 5 points." Conclusion: the patient has a high risk of developing OA of allergic genesis. Appendectomy performed. The histological diagnosis of the removed 40 confirmed the diagnosis of OA, the histological picture testified in favor of the allergic nature of the inflammation.

Clinical example 2. Patient M., 25 years old. Received complaints of pain in the lower abdomen, nausea. Sick for 8 hours. On examination, moderate soreness in the lower abdomen, appendicular symptoms are mild, there are no symptoms of peritoneal irritation. Preliminary diagnosis: intestinal colic? acute appendicitis? A patient was examined according to the proposed method, as a result of which the following data were obtained: positive allergic history - 2 points; LII 1.2-2 points. IROA was 4 points. The obtained IROA value is included in the interval "less than 5 points". Conclusion: the patient has a low risk of developing OA. Diagnosed with intestinal colic. During follow-up, the diagnosis of OA was not confirmed.

The technical result obtained by the implementation of the proposed method:

informativeness and safety of the method;

the possibility of diagnosing OA in clinically difficult cases;

the possibility of determining the tactics of further treatment of the patient in the early stages of the disease.

The developed non-invasive diagnostic method expands the arsenal of tools for the diagnosis of acute appendicitis of allergic genesis and allows you to timely resolve issues of conservative or surgical management of the patient.

Information sources

1. Sovtsov S.A. Acute appendicitis: controversial issues. Surgery 2002; 1: 59-61.

2. Shulutko A.M., Natroshvili A.G., Nasirov F.N. Instrumental diagnosis of acute appendicitis. Russian Medical Journal 2003; 1: 51-53.

3. Milkov B.O., Kokoshchuk G.I., Kulachek F.G. et al. Dynamics of the lysosomal-cationic test in patients with appendicitis before and after surgery. Clinical Surgery 1991; 1: 25-27.

Claims (1)

A method for the diagnosis of acute appendicitis of allergic genesis, which consists in determining the risk factors for the development of acute appendicitis and assigning them points, with: a positive allergic history, 2 points; violation of the diet on the eve of the disease - 2 points; earlier abdominal pain - 1 point; leukocyte intoxication index (LII) more than 1 and less than 0.5-2 points; the level of C-reactive protein more than 5 mg / l - 2 points; peripheral blood IgG level more than 16.6 g / l - 2 points; peripheral blood IgE level of more than 100 IU / ml - 2 points; the level of circulating immune complexes is more than 100 cu - 2 points, summarize the points obtained, thereby determining the risk index for the development of acute appendicitis (IROA), and with a value of IROA less than 5 points, a low risk is predicted, and with a value of IROA equal to or more than 5 points, a high risk of developing acute appendicitis of allergic genesis .