Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

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EP.FRI.479 Clinical accuracy of u/sound combined with inflammatory markers in Acute Appendicitis

British Journal of Surgery ◽

10.1093/bjs/znab312.080 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Nadia Gulnaz ◽

Sadia Tasleem ◽

Farooq Abdullah

Keyword(s):

Acute Appendicitis ◽

Clinical Diagnosis ◽

Inflammatory Markers ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Negative Appendectomy ◽

Care Hospital ◽

Clinical Accuracy ◽

Negative Appendicectomy ◽

Sensitivity Specificity

Abstract Traditionally acute appendicitis has been a clinical diagnosis based on patients' history and physical examination, but the accuracy of clinical diagnosis ranges from 70-95%. Pre-operative diagnosis of acute appendicitis still remains an enigmatic challenge, because no single test alone can reduce the rate of negative appendectomy. Hence some authors have recommended a combination of two or more investigations to increase accuracy and therefore the use of imaging is gaining support. The objective of the study was to determine the clinical accuracy of ultrasound, combined with inflammatory markers such as CRP, WBC, and neutrophilia keeping histopathology as the gold standard. Methods The study was conducted in a Tertiary care hospital in Peshawar from September 2014 to March 2015 on 250 patients who were clinically diagnosed with acute appendicitis. All these patients underwent u/sound scanning in addition to blood tests. Findings In this study, WBC had the highest sensitivity (77.68%) followed by neutrophil% (69.96%), CRP(67.10%), and U/Sound (62.96%) respectively. While U/Sound had the highest specificity (70.59%) followed by CRP and TLC (64.71% each) and neutrophil% (58.82%) respectively. When all the four tests were combined the sensitivity, specificity, (99.17% and 98.45%) increased significantly. When all four tests were negative, appendicitis could be safely ruled out. Conclusion Acute appendicitis is very unlikely and surgery can be safely deferred in these patients when all tests are negative thereby reducing the negative appendicectomy rates.

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Comparison of Clinical Features Between Patients with Positive and Negative Appendectomy

10.21203/rs.3.rs-117309/v1 ◽

2020 ◽

Author(s):

Guner Cakmak ◽

Baris Mantoglu ◽

Emre Gonullu ◽

Kayhan Ozdemir ◽

Burak Kamburoglu

Keyword(s):

Acute Appendicitis ◽

Clinical Features ◽

Total Bilirubin ◽

Negative Appendectomy ◽

C Reactive Protein ◽

Future Studies ◽

Female Patients ◽

Reactive Protein ◽

Male Patients ◽

The Mean

Abstract Background: The objective of this study was to retrospectively compare clinical features and prognostic values between the patients who were referred to the general surgery clinic of our hospital with the presumed diagnosis of acute appendicitis and underwent positive or negative appendectomy.Methods: Patients were divided into two groups as positive (PA) (n:362) and negative appendectomy (NA) (n:284) and the data obtained were compared between these two groups.Laboratory investigations were performed in all patients, and white blood cell (WBC), mean platelet volume (MPV), neutrophils count (NEU), neutrophils (%) (NEU%), C-reactive protein (CRP) and total bilirubin (TBIL) values were studied.Results: The mean MPV value was found as 7.88 fl in PA groups and 8.09 fl in NA group, and the mean MPV value was not statistically significantly difference in PA group, compared to NA groups (p=0.012). Laboratory parameters were also compared between genders. Accordingly, the mean MPV value was statistically significantly higher in female patients compared to male patients in PA group (p = 0.04). The mean TBIL value was 0.97 mg/dl in PA group and 0.69 mg/dl in NA group, and the mean TBIL value was statistically significantly higher in PA group (p< 0.001). Finally, TBIL value was statistically significantly lower in female patients compared to male patients in NA and PA group (p < 0.05).Conclusions: According to the results of our study, MPV and T. BIL values differ in PA and NA groups depending on gender. Therefore, these values may not be used as specific biomarkers in predicting positive acute appendicitis. We believe that these results will contribute to the literature and will be guiding for future studies.

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Clinical Algorithm for Acute Appendicitis in Reducing Negative Appendectomy Rate (NAR)

International Journal of Science and Research (IJSR) ◽

10.21275/art20175365 ◽

2017 ◽

Vol 6 (7) ◽

pp. 646-649

Keyword(s):

Acute Appendicitis ◽

Negative Appendectomy ◽

Clinical Algorithm ◽

Negative Appendectomy Rate

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Abdominal Computed Tomography in the Evaluation of Acute and Perforated Appendicitis in the Community Setting

The American Surgeon ◽

10.1177/000313480707301017 ◽

2007 ◽

Vol 73 (10) ◽

pp. 1002-1005 ◽

Cited By ~ 2

Author(s):

D.O. Vu Huynh ◽

Fariborz Lalezarzadeh ◽

Shokry Lawandy ◽

David T. Wong ◽

Victor C. Joe

Keyword(s):

Computed Tomography ◽

Acute Appendicitis ◽

Predictive Value ◽

Perforated Appendicitis ◽

Community Setting ◽

Diagnostic Value ◽

Academic Community ◽

Negative Appendectomy ◽

Community Based ◽

Abdominal Computed Tomography

Several studies report sensitivity and specificity of abdominal computed tomography scans (CT) for the evaluation of acute appendicitis as high as 98 per cent. Despite increased utilization of CT, the rate of negative appendectomy has remained constant at 10 to 20 per cent. The objective of this study was to assess the effectiveness of CT in the evaluation of acute and perforated appendicitis in an academic community-based setting. A retrospective review of 550 patient charts with International Classification of Diseases-9 (ICD-9) codes for acute and perforated appendicitis from January 2002 to October 2005 was performed. Sensitivity of CT was 87 per cent with a positive predictive value of 92 per cent. Specificity was 42 per cent with a negative predictive value of 29 per cent. Negative appendectomy rates were similar with or without CT (11% vs 13%, respectively). Our data suggests that CT used liberally in everyday practice in a community-based setting to evaluate acute appendicitis may not have as strong of a diagnostic value as those used in protocol-driven research studies. Further prospective studies are needed to formulate criteria to better delineate the role of CT in the evaluation of acute appendicitis.

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Outcome of diagnosed cases of appendicitis and diagnostic accuracy of ultrasound of the appendix

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v13i1.27691 ◽

2020 ◽

Vol 13 (1) ◽

pp. 56-59

Author(s):

Bhoj Raj Sharma ◽

Nawaraj Paudel ◽

Santwana Parajuli ◽

Sushma Singh ◽

Madhu Maya Timilsina

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Surgical Outcome ◽

Perforated Appendicitis ◽

College Teaching ◽

Free Fluid ◽

Pelvic Cavity ◽

Negative Appendectomy ◽

Ultrasound Scan ◽

Suspected Appendicitis

Background: Acute appendicitis is the most common condition requiring an emergency ultrasound scan as well as surgery. Several scoring systems for acute appendicitis has been suggested to improve diagnostic accuracy and decrease the negative appendectomy rate. In this study, we have evaluated the diagnostic performance of ultrasound on the diagnosis of acute appendicitis, other appendicular pathology, and correlate with surgical outcome. Material and methods: This retrospective study included 776 cases of ultrasound scan reports in which the appendix was visualized and not visualized or equivocal. Data were collected from October 2014 to April 2019 from different department and wards of Gandaki Medical College Teaching Hospital and Research Center (GMCTHRC). All the cases with diagnosed acute appendicitis, appendicular lump, and appendicular abscess were included and were followed for its surgical outcome. The surgical note or post-operative findings served as the reference standard for determining whether perforation was present or not. Result: There were 776 ultrasound scans for suspected appendicitis out of which 423 (54.5%) were diagnosed as appendicular pathology. Out of 423 diagnosed cases, 192 (45.4%) were males and 231 (54.6%) were females, with age ranging from 24 months to 87 years. Sonographic findings, in these positive subjects, suggested acute appendicitis, appendicular lump, abscess, and amount of free fluid in right iliac fossa (RIF) and pelvic cavity. Frank acute appendicitis was present in 378 (89.3%) cases, eight (1.9%) cases had an appendicular abscess, 23 (5.4%) had an appendicular lump and 14 (3.3%) had perforated appendicitis. Conclusion: We conclude that ultrasound is a good modality for visualization of appendicitis with other appendicular pathology. We could follow a structured report and identify pathology more specifically. Ultrasound is an easy and non-invasive test to investigate.

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Are Preoperative CT Findings Useful for Predicting Postoperative Intraabdominal Abscess in the Patients with Acute Appendicitis?

Medicina ◽

10.3390/medicina55010006 ◽

2019 ◽

Vol 55 (1) ◽

pp. 6 ◽

Cited By ~ 3

Author(s):

Kohga Kohga ◽

Kiyoshige Yajima ◽

Takuya Okumura ◽

Kimihiro Yamashita ◽

Jun Isogaki ◽

...

Keyword(s):

Acute Appendicitis ◽

Medical Records ◽

Independent Predictor ◽

Univariate Analysis ◽

Operation Time ◽

Intraabdominal Abscess ◽

Ct Findings ◽

Free Air ◽

Preoperative Ct ◽

Ct Finding

Background and objective: In patients with acute appendicitis (AA), preoperative computed tomography (CT) findings suggesting development of intraabdominal abscess (IAA) had not been widely used. The aim of this study was to investigate the preoperative clinical and radiological factors that predict the development of a postoperative IAA in patients with AA who were treated by laparoscopic appendectomy (LA). Methods: Two hundred and sixteen patients with pathologically proven AA underwent LA between January 2013 and March 2018 in our department. Medical records and preoperative CT images of these 216 patients were retrospectively reviewed and the predictive factors of postoperative IAA were investigated. In addition, patients were divided into complicated appendicitis (CA) and simple appendicitis (SA) and perioperative factors of two groups were compared. Results: One hundred and forty-seven patients were diagnosed with CA, while the other 69 patients were diagnosed with SA. Sixteen patients developed postoperative IAA in the CA group, while no patients in the SA group did. The univariate analysis revealed that time from onset to surgery more than 3 days (p = 0.011), the preoperative CT finding of periappendiceal fluid (p = 0.003), abscess (p < 0.001), and free air (p < 0.001), operation time more than 120 min (p = 0.023) and placement of a drainage tube (p < 0.001) were significantly associated with the development of IAA. Multivariate analysis revealed that the preoperative CT finding of free air was independently associated with the development of IAA (p = 0.007, odds ratio = 5.427, 95% CI: 1.586–18.57). Conclusions: IAA developed predominantly in patients with CA. Preoperative CT findings of free air was found to be an independent predictor for the development of IAA. Surgeons should be meticulous in managing the postoperative course of patients with this finding.

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Can Computed Tomography Scan be Performed Effectively in the Diagnosis of Acute Appendicitis without the Added Morbidity of Rectal Contrast?

The American Surgeon ◽

10.1177/000313480807401007 ◽

2008 ◽

Vol 74 (10) ◽

pp. 917-920 ◽

Cited By ~ 1

Author(s):

Daniel D. Dearing ◽

Jamesa Recabaren ◽

Magdi Alexander

Keyword(s):

Acute Appendicitis ◽

Predictive Value ◽

Ct Scanning ◽

Ct Scans ◽

Negative Appendectomy ◽

Suspected Appendicitis ◽

Ct Examination ◽

Preoperative Ct ◽

Negative Appendectomy Rate ◽

Pathology Reports

The highest degrees of accuracy have been demonstrated for CT scans using rectal contrast in diagnosing appendicitis. However, the administration of rectal contrast is associated with patient discomfort and rarely, rectosigmoid perforation (0.04%). Additionally, the commonly accepted negative appendectomy rate is around 16 per cent. We performed a retrospective review of radiology, operative, and pathology reports of consecutive patients undergoing appendectomy or CT examination for appendicitis during 2006. CT scans were performed without rectal contrast. The accuracy of each type of inpatient CT examination and negative appendectomy rates were determined. Two hundred and thirty-eight patients underwent appendectomy. One hundred and thirty-four appendectomy patients (56%) received a preoperative CT scan. The negative appendectomy rates were 6.3 per cent overall, 8.7 per cent without CT examination and 4.5 per cent with CT (P = 0.3). Two hundred and forty-five inpatient CT scans were performed for suspected appendicitis with a sensitivity of 90 per cent, specificity of 98 per cent, accuracy of 94 per cent, positive predictive value of 98 per cent, and negative predictive value of 91 per cent. CT scanning without rectal contrast is effective for the diagnosis of acute appendicitis making rectal contrast, with its attendant morbidity, unnecessary. The previously acceptable published negative appendectomy rate is higher than that found in current surgical practice likely due to preoperative CT scanning.

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Acute appendicitis: a 2- year review of clinical presentation and histopathology

Journal of Pathology of Nepal ◽

10.3126/jpn.v1i2.5402 ◽

1970 ◽

Vol 1 (2) ◽

pp. 104-107 ◽

Cited By ~ 3

Author(s):

N Subedi ◽

US Dangol ◽

MB Adhikary ◽

S Pudasaini ◽

R Baral

Keyword(s):

Acute Appendicitis ◽

Clinical Diagnosis ◽

Clinical Presentation ◽

Histopathological Examination ◽

Iliac Fossa ◽

Operative Procedure ◽

Lymphoid Hyperplasia ◽

Negative Appendectomy ◽

Histopathological Correlation ◽

The Right

Background: Acute appendicitis is the most common surgical emergency. Obstruction of the lumen by fecolith is the usual cause of acute appendicitis.The aim of the study was to analyze clinical presentation of acute appendicitis and its histopathological correlation. Materials and Methods: A retrospective study of acute appendicitis was done in the Department of Surgery of Helping Hands Community Hospital from January 2009 to December 2010. Three hundred forty five patients out of 415 patients with clinical diagnosis of appendicitis underwent operative treatment. The histopathological reports were reviewed and correlated with clinical diagnosis. Results: Out of 345 patients who underwent operative procedure 98% (n= 338) came with chief complaint of pain in the periumbilical region migrating to the right iliac fossa. The mean age of presentation was 42 years. Increased leucocyte count was seen in only 65% cases. Acute appendicitis was more commonly seen in male patients (214 cases, 62%). The most common per operative finding was acutely inflammed appendix (84%) followed by perforated appendix (7.5%), gangrenous appendix (3.5%) and appendicular lump (1.5%). However, histopathological diagnoses were acute appendicitis (91.9%), resolving appendicitis (3.5%), lymphoid hyperplasia (2.6%), mucocele (0.3%) and carcinoid (0.3%). Normal histology was seen in 1.4% cases. Conclusion: Though there are other causes of acute abdomen, acute appendicitis still stands first amongst all the emergencies. Histopathological examination of appendectomy specimen should not be omitted in order to see the incidence negative appendectomy rate and to avoid complications relating to malignant conditions. Keywords: Acute appendicitis; Appendectomy; Appendicular perforation; Histopathology DOI: http://dx.doi.org/10.3126/jpn.v1i2.5402 JPN 2011; 1(2): 104-107

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