Observation versus operation for abdominal pain in the right lower quadrant. Roles of the clinical examination and the leukocyte count.

In-hospital observation of patients with abdominal pain in the right lower quadrant has been suggested as a means of improving diagnostic accuracy and of decreasing the incidence of negative laparotomy. An analysis of 97 patients brought to the operating room over a 12 month period in a university hospital suggests that patients with the classic pattern of migratory pain, rebound tenderness, and an increased number of metamyelocytes in the peripheral blood smear most likely require operation. Leukocytosis alone was not predictive of a surgically remediable disease, which suggests that a period of observation in patients with atypical patterns of pain and no peritoneal signs is a sound treatment plan.