Ultrasonography in the diagnosis of acute appendicitis

Ooms, H. W. A.; Koumans, R. K. J.; You, Peng; Puylaert, J. B. C. M.

doi:10.1002/bjs.1800780316

Cited by 91 publications

(55 citation statements)

References 11 publications

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“…The criteria of AP diameter and wall thickness were suggested by R. Brooke Jeffery Jr [2,3] and his fi ndings were confi rmed by David H. Adams et al [4] and Ooms and Associates [5]. Wide variations in sensitivity, specifi city and positive predictive value of ultrasonography have been reported [6,7].…”

Section: Discussionmentioning

confidence: 96%

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

Sharma

Kasliwal²,

Sharma³

2007

Indian J Surg

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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.

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Section: Discussionmentioning

confidence: 96%

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

Sharma

Kasliwal²,

Sharma³

2007

Indian J Surg

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“…The first error leads to an unnecessary operation and the second to delay. 1 The existence of recurrent and chronic appendicitis is still doubted by many. A recent study of treatment of appendicitis presenting with antibiotics alone found that 95% resolve, but 35% represented with appendicitis within 17.2 months.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Clinic-Histopathological Findings in Different Forms of Appendicitis

Yashwanth¹,

Dileep²

2016

jemds

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BACKGROUNDThe existence of recurrent and chronic appendicitis is still doubted by many. This study is intended to study correlation of clinical findings, operative findings and the histopathological findings among the different {(acute and chronic (recurrent)} forms of appendicitis, to study the recurrence of appendicitis in patients with acute appendicitis who were treated non-surgically at first presentation, to compare the operative and histopathological findings in acute and chronic (recurrent) forms of appendicitis. MATERIALS AND METHODSA total of 100 consecutive cases of suspected appendicitis who were admitted, investigated and treated were taken up for the study. Data related to the objectives of the study were collected. After detailed examination and investigations the clinical, sonological, operative and histopathological findings were correlated. RESULTS 1. Age group of patients ranged from 5 yrs. to 60 yrs. with a mean age of 25.35 yrs. with an S. D. of 9.3 yrs. 2. The sex distribution was almost equal with 49% males and 51% females. 3. Maximum occurrence of appendicitis was in the age group of 21 -30 yrs. 4. There was history suggestive of acute appendicitis in the past, which was managed non-surgically was present in 81% of the patients. 5. Right iliac fossa tenderness was the predominant sign present in 100% of patients. It was mildly tender in 55% of patients suggestive of a chronic (recurrent) form and moderate-to-severely tender in 45% of patients suggestive of an acute form of appendicitis. 6. Per-operatively, the appendix appeared non-inflamed in 57% of patients suggestive of a chronic (recurrent) form and inflamed in 43% of patients suggestive of an acute form of appendicitis. 7. The histopathological studies revealed chronic inflammatory cells in 63% of the resected specimens, suggestive of chronic appendicitis and acute inflammatory cells in 37% of the specimens suggestive of acute appendicitis. CONCLUSIONWe conclude that the Clinical findings, Operative findings and the Histopathological findings correlate with one another (P < 0.001). The surgeon's clinical and operative findings have specificity of around 87.30% and 90.47% respectively. Hence, the diagnostic accuracy of the surgeon is directly dependent on the surgeon's expertise and there is no substitution for an experienced surgeon's judgement.

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“…Prospective studies have shown that the overall accuracy of US in diagnosing acute appendicitis ranges between 87-96% (sensitivity 75-90%, specificity 86-100%) with positive and negative predictive values of 91-94% and 89-97% respectively [3,4,5,12]. In experienced hands US significantly improves diagnostic accuracy in suspected appendicitis while reducing the negative laparotomy rate to 8-15% [13].…”

Section: Discussionmentioning

confidence: 99%