Diagnostic Challenges in Acute Appendicitis

Harrison, Sanjay; Benziger, Harrison

doi:10.5772/25696

Cited by 3 publications

(3 citation statements)

References 92 publications

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“…Gently squeezing the appendix stump with a Johan or other non-toothed grasper, will often yield a faecolith that should be carefully removed and as we know is often the causative agent in appendicitis 7. Other technical points to consider are that direct visualisation of the appendix at all times until safely in a bag to minimise risk of inadvertent contamination from appendix contents.…”

Section: Discussionmentioning

confidence: 99%

Retained faecolith: an avoidable complication of laparoscopic appendicectomy

Knight¹,

Brar²,

Clark³

2013

BMJ Case Reports

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Section: Discussionmentioning

confidence: 99%

Retained faecolith: an avoidable complication of laparoscopic appendicectomy

Knight¹,

Brar²,

Clark³

2013

BMJ Case Reports

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“…Acute appendicitis, which has a lifetime prevalence of approximately one in seven worldwide, presents as an abdominal surgical emergency in which a delay or missed diagnosis can lead to complications resulting in morbidity and mortality [ 1 ]. With clinical assessment playing a major role in diagnosis and treatment, subtle clinical features in early stages and atypical presentation make diagnosis challenging, even for an experienced clinician [ 2 ]. Tests and procedures used to diagnose appendicitis include a wide range of options from physical examination, blood tests, and urine tests to imaging tests such as an abdominal X-ray, abdominal ultrasound, computerized tomography scan, or magnetic resonance imaging to help confirm appendicitis or find other causes for the patient's pain [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…A score of seven or more is considered highly suggestive of acute appendicitis. USG scoring criteria are based on reports by Stephens et al, Harrison et al, Fu et al [ 1 , 2 , 9 ]; a sonological score of more than six is diagnostic of appendicitis. The present study was planned to determine the reliability of already existing MAS and USG findings individually and together in the diagnosis of acute appendicitis correlating with the operative findings and histopathological outcome of the appendix specimen.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Diagnostic Reliability of Modified Alvarado Scores and Abdominal Ultrasonography in Acute Appendicitis

Bhardwaj¹,

Behura²,

Mohapatra³

et al. 2023

Cureus

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Introduction Acute appendicitis is a common surgical emergency. Clinical assessment plays a major role; however, subtle clinical features in early stages and atypical presentation makes diagnosis challenging. Ultrasonography (USG) of the abdomen is a usual investigation that aids in diagnosis, however, it is operator dependent. A contrast-enhanced computed tomography (CECT) of the abdomen is more accurate; however, it exposes the patient to hazardous radiation. The study aimed to combine clinical assessment and USG abdomen in the reliable diagnosis of acute appendicitis. Objectives The objective of this study was to assess the diagnostic reliability of the Modified Alvarado Score and ultrasonography of the abdomen in acute appendicitis. Material and methods All patients with right iliac fossa pain, clinically suspected of having acute appendicitis, admitted to the department of general surgery, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, between January 2019 and July 2020, who gave consent were included. Clinically, Modified Alvarado Score (MAS) was calculated, after which patients were subjected to USG abdomen, where findings were noted and a sonologic score was calculated. The study group was the patients who needed appendicectomy (n=138). Operative findings were noted. Histopathological diagnosis of acute appendicitis was deemed as confirmatory in these cases and was correlated with MAS and USG scores to determine diagnostic accuracy. Results A combined clinicoradiological (MAS + USG) score of seven showed a sensitivity of 81.8% and a specificity of 100%. The specificity of score seven or above was 100%; however, the sensitivity at 81.8%. The diagnostic accuracy of the clinicoradiological was 87.5%. The negative appendicectomy rate was 4.34%, with a diagnosis of acute appendicitis being confirmed for 95.7% of patients upon histopathological examination. Conclusion The MAS and USG of the abdomen, which is an affordable and non-invasive tool, showed increased diagnostic reliability, and hence it can help reduce the use of CECT abdomen, as CECT abdomen is considered as a gold standard for confirmation or exclusion of diagnosis of acute appendicitis. Use of the combined scoring system of MAS and USG abdomen can be used as a cost-effective alternative.

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Efficacy of the Modified Alvarado Scoring System and Radiologic Studies in Diagnosing Appendicitis in Children: A Retrospective Comparative Study

Mnofala,

Tashkandi,

Halawani

et al. 2024

Cureus

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Background: Appendicitis is a common diagnostic challenge in pediatric patients. Based on clinical and laboratory findings, the modified Alvarado scoring system (MAS) is commonly used to assess the likelihood of appendicitis. This study aims to evaluate the diagnostic performance of MAS compared to radiologic findings and its components in the diagnosis of appendicitis in children.Methods: This retrospective study involved 177 pediatric patients with abdominal pain. The MAS, radiologic examinations (ultrasound), and physical examination findings were evaluated. Data on MAS, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were analyzed. Chi-square tests were used to determine significant differences between MAS and radiologic findings.Results: The study included 92 males (52%) and 85 females (48%), with the majority (95, 53.7%) in the age group of 7-10 years. Of the 177 patients, 46 (26%) had positive radiologic findings for appendicitis. The MAS showed a sensitivity of 81%, a specificity of 69%, a PPV of 48%, and an NPV of 91%. A significant difference in the MAS was found between patients with positive and negative radiologic findings (p = 0.001). Compared with ultrasound, MAS showed a PPV of 39%, an NPV of 14%, a sensitivity of 48%, a specificity of 80%, an accuracy of 73%, and an odds ratio of 3.69. Rebound tenderness on physical examination also showed a significant association with appendicitis (p = 0.001).Conclusions: This study highlights the potential of the MAS as a valuable tool for the initial assessment of appendicitis in children, demonstrating high sensitivity and NPV. Although it has a moderate PPV and specificity, suggesting efficacy in ruling out appendicitis, it should be supplemented with radiologic findings for a definitive diagnosis. Tenderness remains a crucial clinical sign, emphasizing its importance on physical examination. These findings should guide future research to refine the MAS components and explore complementary diagnostic strategies to improve the accuracy of pediatric appendicitis diagnosis.

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Diagnostic Challenges in Acute Appendicitis

Cited by 3 publications

References 92 publications

Retained faecolith: an avoidable complication of laparoscopic appendicectomy

Retained faecolith: an avoidable complication of laparoscopic appendicectomy

Assessment of the Diagnostic Reliability of Modified Alvarado Scores and Abdominal Ultrasonography in Acute Appendicitis

Efficacy of the Modified Alvarado Scoring System and Radiologic Studies in Diagnosing Appendicitis in Children: A Retrospective Comparative Study

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