The role of immature granulocyte in the early prediction of gastrointestinal tract perforations

Immature granulocyte and gastrointestinal tract perforation



Gastrointestinal tract, Perforation, Percentage of immature granulocytes, Immature granulocytes


Background/Aim: Gastrointestinal system (GIS) perforations cause acute abdomen an indication for emergency intervention. Early detection is very important in gastrointestinal perforations to prevent mortality and morbidity. This study aimed to examine whether immature granulocyte (IG) and IG percentages (IG%) can be used as a simple and easy marker for identifying gastrointestinal system perforations early on.

Methods: Between January 1, 2020, and January 1, 2022, 120 patients who presented to Hitit University Erol Olçok Training and Research Hospital's emergency service and underwent surgery on by the General Surgery Clinic with the diagnosis of the acute abdomen were investigated. The patients were divided into two groups. Patients in group 1 included those with peptic ulcers and bowel perforations. Group 2 was considered the control group. Of the 36 patients in group 2, 22 had acute appendicitis, 12 had ileus-related bridectomy or bowel resection, and two had acute cholecystitis. The common patient feature in this group was full-thickness or serosal iatrogenic bowel injury and repair. Pre-operative IG and IG% values were obtained from routine complete blood count values. IG and IG% values were compared between groups 1 and 2, and the predictive value of these biomarkers in the early diagnosis of GIS perforations was investigated.

Results: The mean age of the patients was 55.49 (19.58). The study consisted of 45 (37.5%) female patients and 75 (62.5%) male patients. Group 1 had 84 patients, whereas Group 2 had 36. When the two groups were evaluated, the IG value was higher in Group 1 (P < 0.001). In terms of the percentage value of immature granulocytes, a statistically significant difference was found between Groups 1 and 2 (P = 0.001). As a result, Group 1's IG and IG% values were much greater than those in Group 2.

Conclusion: IG and IG% values are inflammatory parameters that can be easily studied in routine hematology tests. According to this study, IG and IG% values were found to be higher in gastrointestinal tract perforations based on result blood tests taken at the time of admission to the emergency department.


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Yeung KW, Chang MS, Hsiao CP, Huang JF. CT evaluation of gastrointestinal tract perforation. Clin Imaging. 2004;28:329-33. DOI:

Hainaux B, Agneessens E, Bertinotti R, De Maertelaer V, Rubesova E, Capelluto E, et al. Accuracy of MDCT in predicting the site of gastrointestinal tract perforation. AJR Am J Roentgenol. 2006;187:1179-83. DOI:

Senthilnayagam B, Kumar T, Sukumaran J, M J, Rao K R. Automated measurement of immature granulocytes: performance characteristics and utility in routine clinical practice. Patholog Res Int. 2012;2012:483670. doi: 10.1155/2012/483670. Epub 2012 Feb 15. PMID: 22448336; PMCID: PMC3289863. DOI:

Park JH, Byeon HJ, Lee KH, Lee JW, Kronbichler A, Eisenhut M, et al. Delta neutrophil index (DNI) as a novel diagnostic and prognostic marker of infection: a systematic review and meta-analysis. Inflamm Res. 2017;66:863-70. DOI:

Ansari-Lari MA, Kickler TS, Borowitz MJ. Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis. Am J Clin Pathol. 2003;120:795-9. DOI:

Nigro KG, O’Riordan M, Molloy EJ, Walsh MC, Sandhaus LM. Performance of an automated immature granulocyte count as a predictor of neonatal sepsis. Am J Clin Pathol. 2005;123:618-24. DOI:

Kılıç BŞ, Atakul N. Effect of platelet large cell ratio (PLCR) and immature granulocyte (%IG) values on prognosis in surgical site infections J Surg Med. 2021;5(6):588-92. DOI:

Wang R, He J, Chen Z, Wen K. Migration of fish bones into abdominal para-aortic tissue from the duodenum after leading to duodenal perforation: a case report. BMC Gastroenterol. 2021;21(1):82. . DOI:

Del Gaizo AJ, Lall C, Allen BC, Leyendecker JR. From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography. Abdom Imaging. 2014;39(4):802-23. DOI:

Picone D, Rusignuolo R, Midiri F, Casto AL, Vernuccio F, Pinto F et al. Imaging assessment of gastroduodenal perforations. Semin Ultrasound CT MR. 2016;37(1):16-22. DOI:

Drakopoulos D, Arcon J, Freitag P, El- Ashmawy M, Lourens S, Beldi G, et al. Correlation of gastrointestinal perforation location and amount of free air and ascites on CT imaging. Abdominal Radiology. 2021;46:4536-47. DOI:

Miller RE, Nelson SW. The roentgenology demonstration of tiny amounts of free intraperitoneal gas: experimental and clinical studies. Am J Roentgenol Radium Ther Nucl Med. 1971;112:574-85. DOI:

Lo Re G, Mantia FL, Picone D, Salerno S, Vernuccio F, Midiri M. Small bowel perforations: what the radiologist needs to know. Semin Ultrasound CT MR. 2016;37(1):23-30. DOI:

Rajaguru K, Sheong SC. Case report on a rare cause of silent duodenal perforation. Int J Surg Case Rep. 2020;76:320-23. DOI:

Ilgar M, Elmalı M, Nural MS. The role of abdominal computed tomography in determining perforation findings and site in patients with gastrointestinal tract perforation Ulus Travma Acil Cerrahi Derg. 2013;19(1):33-40. DOI:

Fernandes B., Hamaguchi Y. Automated enumeration of immature granulocytes. Am J Clin Pathol. 2007;128:454-63. DOI:

Lee H, Kim IK, Ju MK. Which patients with intestinal obstruction need surgery? The delta neutrophil index is an early predictive marker. Ann Surg Treat Res. 2017;93:272-6. DOI:

Lipiński M, Rydzewska G. Immature granulocytes predict severe acute pancreatitis independently of systemic inflammatory response syndrome. Prz Gastroenterol. 2017;12:140-4. DOI:

Ünal Y, Barlas AM. Role of increased immature granulocyte percentage in the early prediction of acute necrotizing pancreatitis. Ulus Travma Acil Cerrahi Derg. 2019;25:177-82. DOI:

Dogan M, Gürleyen B. The role of immature granulocyte in the early prediction of acute perforated and nonperforated appendicitis in children Ulus Travma Acil Cerrahi Derg. 2022;28(3):375-81. DOI:

Senlikci A, Kosmaz K, Durhan A, Suner MO, Bezirci R, Mercan U, et al. A New Marker Evaluating the Risk of Ischemic Bowel in Incarcerated Hernia: Immature Granulocytes Indian Journal of Surgery. 2021:2021;1-5. DOI:






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Durak D, Turhan VB. The role of immature granulocyte in the early prediction of gastrointestinal tract perforations: Immature granulocyte and gastrointestinal tract perforation. J Surg Med [Internet]. 2022 Jul. 29 [cited 2024 May 25];6(7):670-3. Available from: