Evaluation of negative appendicectomy rate in cases of suspected acute appendicitis and to study the usefulness of ultrasonography in improving the diagnostic accuracy

Abstract

Context Acute appendicitis poses a signifi cant diagnostic challenge to the surgeon. Despite modern advances, the diagnosis of appendicitis remains essentially clinical. Ultrasonography is effective in supplementing the clinical diagnosis.Aims This study aims to evaluate the negative appendicectomy rate in patients subjected to appendicectomy and to assess the usefulness of ultrasound in improving the diagnostic accuracy. Settings and DesignIt is a retrospective review of prospectively collected data on 118 patients operated for suspected acute appendicitis in a single surgical unit between May 2001 and December 2002. Methods and MaterialThe detailed history, clinical examination and preoperative investigations according to protocol were recorded on a proforma. All patients underwent an ultrasonography of whole abdomen including pelvis. Each patient with suspected acute appendicitis was subjected to surgery and appendix was submitted for histopathological examination. The negative rate of appendicectomy, sensitivity and specifi city of ultrasonography and positive and negative predictive value of ultrasound were calculated.Results The negative appendicectomy rate was 23.72%. In males it was 13.43% and in females 37.25%. Ultrasonography had a sensitivity of 63.33 % and a specifi city of 82.14 %. The predictive value of a positive test was 91.93% and the predictive value of a negative test was 41.07%. ConclusionsThe clinical diagnosis of acute appendicitis when supplemented with an ultrasonography, can achieve a reasonable degree of diagnostic accuracy with resultant low negative exploration rates thereby reducing the fi nancial burden and morbidity by avoiding unnecessary appendicectomy and keeping the cost of treatment affordable.Keywords Appendicectomy . Ultrasonography . Negative Rate Key Messages• Despite modern advances in imaging and technology, one can still reliably diagnose acute appendicitis clinically.• It is important to have low negative appendicectomy rates in order to minimize the fi nancial burden and the attendant increased morbidity and late complications like adhesive intestinal obstruction following unnecessary appendicectomy.

A three year prospective study-suspected acute appendicitis: diagnostic accuracy of modified Alvarado score versus ultrasonography in adults

“…Appendiceal perforation can be diagnosed when the appendix demonstrates irregular contour or when peri appendiceal fluid collection are identified. 1,2,7 Doppler ultrasound examination usually reveals increased vascularity in and around the acutely inflamed appendix this examination is useful as an adjunct sign of appendicitis when appendiceal measurement is equivocal, in which it is uncertain as to whether the imaged appendix is normal or inflamed.…”

“…[1][2][3] The condition is difficult to diagnose during the early stages when the classical signs and symptoms are usually subtle. 1,4 Different disease process mimic the diagnosis of acute appendicitis as there are number of causes leading to pain in the right iliac fossa particularly in female patients.…”

“…[1][2][3] The condition is difficult to diagnose during the early stages when the classical signs and symptoms are usually subtle. 1,4 Different disease process mimic the diagnosis of acute appendicitis as there are number of causes leading to pain in the right iliac fossa particularly in female patients. 5,6 It has been observed that many patients undergoing appendectomy prove to be negative on histopathology of the surgically removed appendix, which is the gold standard for diagnosis of appendicitis.…”

“…2 Removing a normal appendix is a burden both on patients and health resources. 1 However, early recognition of the condition and prompt operation have been the most important factors in reducing morbidity and possible mortality length of stay and the cost of treatment. It has been claimed that diagnostic aids can dramatically reduce the number of negative appendectomies.…”

“…Graded compression ultrasonography in diagnosis of acute appendicitis has greatly improved the ability to diagnose acute appendicitis. 1 Ultrasonography is operator dependant and the care to be taken to avoid over interpreting a technically in adequate examination. The accuracy offered by sonography should keep negative laparotomy ratio at approximately 10%, which is improvement over the rate achieved by instinct alone.…”