From the Guidelines
Appendicitis can occur without leukocytosis, and a normal white blood cell count should not rule out the diagnosis, as approximately 10-15% of cases may present without elevated white blood cell counts. The diagnosis of appendicitis without leukocytosis relies on a comprehensive clinical evaluation, including history, physical examination, and imaging studies, such as ultrasound or CT scan, to confirm the diagnosis 1. Patients may still present with classic symptoms, including right lower quadrant pain, migration of pain, anorexia, nausea, and vomiting.
Key Considerations
- The pathophysiology behind normal white blood cell counts in appendicitis may involve early presentation before an inflammatory response develops, immunosuppression, or elderly patients who may have blunted inflammatory responses 1.
- Treatment remains the same as for typical appendicitis, with appendectomy being the standard of care, though selected cases might be managed with antibiotics 1.
- Delaying treatment due to normal white blood cell counts can lead to perforation and increased morbidity, so maintaining clinical suspicion despite normal laboratory values is crucial.
Diagnostic Approach
- A tailored individualized diagnostic approach is recommended, depending on disease probability, sex, and age of the patient 1.
- Clinical scores, such as the AIR score and AAS score, can be useful in diagnosing acute appendicitis, but should not be used alone to confirm the diagnosis 1.
- Imaging studies, particularly ultrasound or CT scan, are essential in confirming the diagnosis of appendicitis, especially in cases without leukocytosis.
Treatment
- Appendectomy is the standard of care for appendicitis, including cases without leukocytosis.
- Antibiotic therapy may be considered in selected cases, but the risk of recurrence and the need for additional diagnostic certainty with a CT-proven diagnosis should be taken into account 1.
From the Research
Appendicitis without Leukocytosis
- The provided studies do not directly address the topic of appendicitis without leukocytosis.
- However, the studies discuss the diagnosis, management, and treatment of acute appendicitis, including the use of antibiotics and surgical interventions 2, 3, 4.
- One study examines the effect of morphine analgesia on patients with acute appendicitis, finding that morphine can reduce pain without affecting diagnostic accuracy 5.
- Another study is unrelated to appendicitis, discussing the significance of rheobase determination in detecting threatened premature labor 6.
- There is no direct evidence in the provided studies to assist in answering the question about appendicitis without leukocytosis.