Original article| Volume 21, ISSUE 1, P47-55, July 1933

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A comparative study of the leucocyte count and histopathology in acute appendicitis

Value of the schilling count in establishing the diagnosis
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      In a series of 277 consecutive operations for appendicitis, 189 were diagnosed acute, 88 non-acute. Schilling's differential blood count was included as a preoperative routine in 173 cases, 104 had the usual white and differential count.
      • 1.
        1. Confirmation of Diagnosis. Disagreement between surgical diagnosis and histologie sections occurred in 15 per cent of all acute cases, in 8 per cent of all non-acute cases. Where Schilling's differential formed a part of the preoperative examination, this disagreement was 3 per cent lower for acute appendicitis, and 2 per cent lower for non-acute, than it was in the series where the usual differential was used. Normal appendices, removed as acute, were increased in the Schilling series, i per cent, forming 7.5 per cent of all acute cases.
      • 2.
        2. Leucocytosis. (a) Leucocytosis occurred in 95.5 per cent of the proved acute cases, in 49 per cent of the non-acute. With the acute cases, leucocytosis was about the same percentage in each series; with the non-acute there were 15 per cent fewer incidences of leucocytosis where Schilling's method had been employed. (b) Leucocytosis of 15,000 or more occurred in 71 per cent of all acute cases, in 5.4 per cent of all non-acute. The degree of leucocytosis was 21 per cent lower for acute, 5 per cent lower for non-acute in the Schilling series as compared with the first series.
      • 3.
        3. Neutrophilia. Neutrophiha above 70 per cent occurred in 92 per cent of all acute cases, in 5.5 per cent of all non-acute. In the Schilling series the incidence was 7 per cent lower for acute, 5 per cent lower for non-acute cases than it was in the control series. The ascending Gibson's line occurred in blood counts of not over 60 per cent of the acute cases, not under 10 per cent of the non-acute.
      • 4.
        4. Schilling's Differential. Immature neutrophiles, in general, increased with the infection:
        Tabled 1
        Degree of Appendicitis Per Cent Immature Forms
        Non-acute Average 13
        Acute 27
        Acute with gangrene, peritonitis, or periappendicitis, not perforated 30
        Acute with perforation 45
        But only 58 per cent of the immature counts in acute appendicitis reached 25 per cent or more; 9 per cent were under 11 per cent immature forms.
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