Acute appendicitis: Factors associated with inconclusive ultrasound study and the need for additional computed tomography

Pelin, M.; Paquette, Brice; Revel, Lucie; Landecy, Marie; Bouveresse, Sébastien; Delabrousse, Éric

doi:10.1016/j.diii.2018.07.004

Cited by 27 publications

(25 citation statements)

References 21 publications

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“…[5,14] The WBC count and the shift to left of WBC is a very important point for the diagnosis of appendicitis, in our study complicated appendicitis was very signi cantly correlated with both elevated WBC count and shift to left of WBC (P values 0.000) for each of them. [3,13,15] The Alvarado scoring system is used widely to diagnose acute appendicitis and decrease the rate of negative appendectomies, many modi cations had been made on this scoring system in order to increase the accuracy of clinical diagnosis, the modi ed Alvarado scoring system add extra clinical signs during examination. Scores more than 7 are labelled as the patients mostly is having acute appendicitis, patients having scores below 7 may be observed or managed conservatively unless some other evidences of appendicitis are present such as typical imaging ndings.…”

Section: Discussionmentioning

confidence: 99%

“…The life time for acute appendicitis is around 7-9%, with slight higher risk for males. [1][2][3][4][5] The pathogenesis of acute appendicitis is well understood, it usually start with increase mucous production, luminal obstruction, bacterial overgrowth, leading to increase on the appendiceal wall, impairment of the blood supply, ischemia, and gangrene and perforation if left untreated. [6] The most important aspect in the management of acute appendicitis, is early diagnosis and intervention to avoid the development of complications.…”

Section: Introductionmentioning

confidence: 99%

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Appraisal of Various Predictors for Complicated Appendicitis in Adults; A Comparative Study Between Complicated and Non-Complicated Appendicitis

Mohammed

2021

Preprint

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Background: Acute appendicitis is the most common non traumatic surgical abdominal emergency, and is the first operation done by most of the general surgeon during their training period. The most important aspect in the management of acute appendicitis, is early diagnosis and intervention to avoid the development of complications.Patients and methods: This prospective study included 184 patients diagnosed with acute appendicitis who were grouped into complicated and non- complicated appendicitis. Both groups were compared to detect predictors for complicated appendicitis to prevent delay management. Results: About 82.6% of our patients were below 30 years (mean: 23.8 years) and 59.2% were females. Histopathology confirmed acute appendicitis in 86.5 %, chronic appendicitis in 12.5%, and normal appendix in 1.1%. About 81.5% have ALVARADO score equal or greater than 7. Complicated appendicitis was diagnosed in 23.37% of patients. There was a significant correlation between complicated appendicitis and gender, rebound tenderness, elevated temperature, elevated WBC, shift to left of WBC and Modified Alvarado Scoring (P values 0.000,0.002,0.001,0.000,0.000, and 0.006), other parameters showed no significant correlations. Conclusion: The rate of complicated appendicitis should be reduced to decrease the associated morbidity, the presence of rebound tenderness, fever, high WBC count and sift to left, a score of 7 or more by modified ALVAADO score, and male sex are highly suggestive. The presence of these factors mandates early and prompt intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Appraisal of Various Predictors for Complicated Appendicitis in Adults; A Comparative Study Between Complicated and Non-Complicated Appendicitis

Mohammed

2021

Preprint

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“…Abdominal fat may interfere with proper diagnosis in imaging modalities. In addition, in non-obese Chinese children, CT resolution was as good as ultrasound (17). Thus, abdominal CT is the best method for diagnosis of abdominal purpura in Chinese children but has the issue of radiation dose.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound, X‑ray, computed tomography and clinical tests for diagnosis of abdominal purpura in children: A retrospective study

Ge¹,

Liu

2020

Exp Ther Med

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Imaging modalities are not included in The European League Against Rheumatism, The Pediatric Rheumatology International Trials Organization and The Pediatric Rheumatology European Society 2010 criteria for the evaluation of abdominal purpura. The objective of the present study was to compare diagnostic parameters of ultrasound, X-ray and computed tomography (CT) for diagnosis of abdominal purpura considering the American College of Rheumatology (ACR) criteria as 'reference standard' in children with acute abdominal pain. Medical records of 215 children with acute abdominal pain were reviewed. Data regarding demographics and clinical characteristics, laboratory tests, X-ray, ultrasound findings, and computed tomographic images were collected and analyzed. Decision curve analysis was used for evaluation of the beneficial score for each diagnostic modality. Among diagnostic modalities, CT had the highest sensitivity (0.939); however, ultrasound findings had the highest accuracy (0.861) for diagnosis of abdominal purpura. Unlike X-ray and laboratory tests, ultrasound and CT were successful at detecting abdominal purpura when children had only colicky pain and were aged <20 years; however, occult blood stool test and granulocytes in the walls of small venules and arterioles (biopsy results) were negative. With respect to the ACR criteria, there were seven and three inconclusive results for ultrasound and CT, respectively. Abdominal ultrasound is an easy, non-invasive and safe method for the detection of abdominal purpura in children.

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“…and can also be limited or technically difficult because of patient (large, fatty or obese) habitus or bowel gases. 12 Advances in diagnostic imaging and early utility of computed tomography (CT) have reduced incidences of negative appendectomies. 13 Many of the patients are found to have either mild degree of acute appendicitis or an alternate aetiology, guiding towards either a non-operative medical management (by observation and/or antibiotic course) or a specific treatment targeting an alternate diagnosis.…”

Section: B a C K G R O U N Dmentioning

confidence: 99%

Usefulness of CT Scan in Diagnosing Acute Appendicitis in Patients with Low Alvarado Scores

Waheed¹,

Shah²,

Alshehri³

et al. 2019

jemds

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BACKGROUND Alvarado score has been routinely used in clinical practice for assessing the probability of acute appendicitis in patients presenting with right lower quadrant abdominal pain. Computed tomography can be used for equivocal or difficult cases. We wanted to evaluate role of computed tomography (CT) in patients with low or equivocal Alvarado scores. METHODS This is a retrospective, observational study conducted in the Department of Radiology at our Hospital in Dhahran from October 2017 to October 2018. 138 patients with equivocal Alvarado scores (AS, 4-6) and negative (non-conclusive or limited) ultrasounds, were retrospectively reviewed. Pregnant, postoperative (bowel surgery) cases and chronic appendicitis cases were excluded. Diagnosis of acute appendicitis on CT was based on a thickened or fluid dilated appendix (diameter > 6mm, wall enhancement) with at least one of the associated findings (like appendicolith, peri-appendiceal fat stranding, free fluid, extra-luminal air foci, caecal base thickening and mesenteric lymph nodes). Imaging findings were reviewed by two radiologists and consensus reporting was made. Findings on CT were categorized as AA (Acute Appendicitis), OD (Other Diagnosis) and NOR (Normal). Surgical candidates were confirmed on histopathology, while nonsurgical cases were followed up on either imaging or clinical grounds. Chi-square test was used to determine association. The main outcome measure was diagnosis on CT and histopathology. RESULTS 29.7% (41 patients) were found to have acute appendicitis on CT imaging. Majority of patients with AS of 5 were having OD, while most of AA cases were having AS of 6. All patients with AS of 4 were having normal CT scans. CONCLUSIONS Computed tomography helps to diagnose acute appendicitis or establish an alternate diagnosis in patients with equivocal Alvarado scores.

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Acute appendicitis: Factors associated with inconclusive ultrasound study and the need for additional computed tomography

Abstract: Advanced age, high BMI, atypical appendix location, and complicated appendicitis are associated with inconclusive ultrasound and the need for further CT to diagnose acute appendicitis.

Cited by 27 publications

References 21 publications

Appraisal of Various Predictors for Complicated Appendicitis in Adults; A Comparative Study Between Complicated and Non-Complicated Appendicitis

Appraisal of Various Predictors for Complicated Appendicitis in Adults; A Comparative Study Between Complicated and Non-Complicated Appendicitis

Ultrasound, X‑ray, computed tomography and clinical tests for diagnosis of abdominal purpura in children: A retrospective study

Usefulness of CT Scan in Diagnosing Acute Appendicitis in Patients with Low Alvarado Scores

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