Published: 2019-06-29

C-reactive protein as a diagnostic tool in acute appendicitis

Usharani Rathnam, Srivignesh Kumar K., Lakkanna Suggaiah


Background: Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall and sepsis. The main objective is to compare C-reactive levels in diagnosis of acute appendicitis.

Methods: In this study patients coming to General Surgery Department of ESIC Medical college, Rajajinagar, Bengaluru, from January 2017 to December 2017, who are diagnosed clinically as to have acute appendicitis form the source of study.

Results: In the present study, maximum number of cases belongs to 21-30 year age group (22 cases) and male female ratio is 1.07:1. Most common site of pain being right iliac fossa (52 cases), vomiting as presenting complaint was seen in 51 cases, fever as a presenting complaint was present in 31 cases, Mc-Burneys point tenderness noted in 49 cases, rebound tenderness noted in 46 cases. In present series 53 patients had elevated serum CRP level (>2.5 mg/dl) which is 89% of total study group. In these patients only one patient had high serum CRP level in spite of normal appendix.

Conclusions: An elevated serum CRP level supports the surgeon’s diagnosis and hence avoids chances of error in diagnosis, due to atypical presentations. Similarly a normal preoperative serum CRP level in patients with suspected acute appendicitis is most likely to be associated with a normal appendix on histo-pathological examination.


C-reactive protein, Acute appendicitis, Abdominal pain

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Graffeo CS, Counselman FL. Appendicitis. Emerg Med Clin North Am. 1996;14(4):653–71.

Hobler K. Acute and suppurative appendicitis: disease duration and its implications for quality improvement. Permanente Medical Journal. 1998;2(2):71-4.

Paulson EK, Kalady MF, Pappas TN. Clinical practice. Suspected appendicitis. N Engl J Med. 2003;348(3):236–42.

Beltrán SM, Tapia TF, Cruces BK, Rojas J, Araya ET, Barraza M, et al. Sintomatología atípica en pacientes con apendicitis: estudio prospectivo. Rev Chil Cir. 2005;57:417-23.

Beltrán MA, Villar MR, Tapia TF. Score diagnóstico de apendicitis: Estudio prospectivo, doble ciego, no aleatorio. Rev Chil Cir. 2004;56:550-7.

Ohmann C, Franke C, Yang Q, Margulies M, Chan M, van Elk PJ, et al. Clinical benefit of a diagnostic score for appendicitis. Arch Surg. 1999;134:993-6.

Zimmerman MA, Selzman CH, Cothren C, Sorensen AC, Raeburn CD, Harken AH. Diagnostic implications of C-reactive protein. Arch Surg. 2003;138:220-4.

Ghimire R, Sharma A, Bohara S. Role of C-reactive protein in acute appendicitis. Kathmandu Univ Med J (KUMJ). 2016;14(54):130-3.

Anshuman S, George B, Simon PB .White cell count and C-reactive protein measurement in patients with possible appendicitis. Ann R Coll Surg Engl. 2009;91(2):113–5.

Amalesh M, Shankar M, Shankar R. CRP in acute appendicitis: is it a necessary investigation? Int J Surg. 2004;2(2):88-9.