An assessment of the value of the menstrual history in differentiating acute appendicitis from pelvic inflammatory disease.

In acute appendicitis, the most difficult group of patients to evaluate is that of women of childbearing age. The results of a recent report showed that women of this age group with acute appendicitis tend to have the onset of symptoms in the luteal phase of the menstrual cycle. In view of this, and since some forms of pelvic inflammatory disease tend to have the onset of symptoms in the menstrual phase of the cycle, a study was undertaken to determine if menstrual history might be of value in differentiating acute appendicitis and PID. In comparing the onset of symptoms of five groups--1, perforated or gangrenous appendicitis; 2, acute suppurative appendicitis; 3, normal appendix; 4, normal appendix with PID (a subgroup of group 3), and 5, PID only--no difference was found in the percentage of patients presenting in each phase of the menstrual cycle among the groups. The incidence of disease (per day) appeared to remain the same between phases of the cycle in each group, suggesting that patients in all groups present in a random manner in relation to the menstrual cycle. We conclude that the menstrual history does not appear helpful in differentiating acute appendicitis and pelvic inflammatory disease in women of childbearing age.