Rectal examination in the differential diagnosis of acute appendicitis in adults

Abstract

Purpose: To investigate the role of routine digital rectal examination in the differential diagnosis of acute appendicitis in adult patients.

Background: Although rectal examination has been suggested as a part of routine physical examination in patients with acute abdominal pain, the literature on this subject does not support its role in the diagnosis of acute appendicitis.

Materials and Methods: One hundred and seventy adult patients diagnosed as acute appendicitis were included into the study, and underwent rectal examination. Findings of rectal examination were classified as normal or pathological. The patient’s discomfort due to rectal examination was evaluated. Operative findings were grouped as acute appendicitis, negative exploration and other intraabdominal pathologies. Intraoperative diagnoses were confirmed with histopathological examination. Pre and postoperative diagnoses were compared regarding the findings of rectal examination.

Results: There was not any difference between the operative and histopathological diagnoses. There were 13 (5 male, 8 female) patients with a diagnosis of negative exploration or other intraabdominal pathologies. Rectal examination was not significant in neither male nor female patients in the diagnosis of acute appendicitis. Severe (16%), moderate (27%) or mild (55%) discomfort was revealed by the patients with normal rectal examination. Overall sensitivity of digital rectal examination was 17%, specificity was 62%, positive predictive value was 84%, negative predictive value was 6% and accuracy was 21%, in the diagnosis of acute appendicitis.

Conclusion: Routine digital rectal examination does not add to the diagnosis or the treatment planning in acute appendicitis, and it may lead to misdiagnosis especially in female patients.