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

2007 ◽  
Vol 73 (10) ◽  
pp. 1002-1005 ◽  
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.

The Use of Abdominal Computed Tomography Imaging Technology in the Treatment of Surgical Acute Abdominal Perforation

2020 ◽  
Vol 10 (9) ◽  
pp. 2130-2135
Author(s):  
Yong Liu ◽  
Tuo Su ◽  
Ping Wei ◽  
Wei Han ◽  
Zhili Ji
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Diagnostic Value ◽  
Imaging Features ◽  
Abdominal Ct ◽  
Imaging Technology ◽  
Abdominal Computed Tomography ◽  
Specific Sign ◽  
Suspected Acute Appendicitis ◽  
Image Performance

Objective: The objective of this study is to explore the imaging features of abdominal Computed Tomography (CT) in patients with surgical acute abdominal perforation and to improve the diagnostic ability of perforated acute appendicitis (PAA). Method: Patients with suspected acute appendicitis and abdominal pain are selected as the study objects. According to the surgical records and pathological results, the patients are divided into PAA group and nonperforated acute appendicitis (NPAA) group. All patients are examined by abdominal CT. Postprocessing reconstruction technology such as multiple planar reconstruction (MPR) algorithm and curved planar reformat (CPR) algorithm are used as assistance to display the appendix, analyze and compare the images, observe the image performance of abdominal CT, and measure the diameter of the appendix. Results: The incidence of PAA specific signs (i.e. cellulitis around the appendix, abscess around the appendix, enhancement defect of the appendix wall, air accumulation outside the appendix cavity, fecal stone outside the appendix cavity) in PAA group is significantly higher than that in NPAA group (P < 0.05). Appearance of at least one specific sign for the diagnosis of PAA is 95.65%, the specificity is 92.59%, and the accuracy is 94.00%. The diameter of appendix in PAA group is significantly larger than that in NPAA group (P < 0.05). Compared with the diagnosis of simple specific signs, the specificity and accuracy of the combination of appendiceal diameter and specific signs in the diagnosis of PAA have been improved. Conclusion: With the help of MPR algorithm and CPR algorithm, abdominal CT imaging technology can accurately identify PAA and NPAA, which has important diagnostic value.

Diagnostic Value of Laparoscopy, Abdominal Computed Tomography, and Ultrasonography in Acute Appendicitis

2013 ◽  
Vol 23 (12) ◽  
pp. 982-989 ◽  
Author(s):  
Ira Bachar ◽  
Zvi Howard Perry ◽  
Larisa Dukhno ◽  
Solly Mizrahi ◽  
Boris Kirshtein
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Diagnostic Value ◽  
Abdominal Computed Tomography

scholarly journals Diagnostic value of clinical and laboratory symptoms in the diagnosis of acute appendicitis in patients with suspected acute appendicitis referring to Imam Reza Hospital in Birjand

2021 ◽  
pp. 151-155
Keyword(s):  
Acute Appendicitis ◽  
Roc Curve ◽  
Predictive Value ◽  
Serum Iron ◽  
Clinical Signs ◽  
Diagnostic Value ◽  
Small Sample ◽  
Pathological Examination ◽  
Negative Appendectomy ◽  
Suspected Appendicitis

Introduction: Appendicitis is a challenging condition for emergency specialists and surgeons to diagnose. If it is not treated in time, the inflamed tissue of the appendix ruptures, causing peritonitis and shock. This study evaluated the diagnostic value of clinical and laboratory symptoms in the diagnosis of acute appendicitis. Methods: This descriptive cross-sectional study was carried out on a total of 134 patients with suspected appendicitis referring to the Emergency Department of Imam Reza Hospital in Birjand, Iran, within 2013 and 2015 using convenience sampling. The data collection tool was a questionnaire covering patients’ demographics, clinical signs, and laboratory and pathology test results. Sensitivity and specificity, positive predictive value, negative predictive value, likelihood ratio, area under the receiver operating characteristic (ROC) curve (AUC), and cut-off point of each test (i.e., white blood cell, aspartate transaminase, alanine transaminase, C-reactive protein, polymorphonuclear leukocytes, lymphocytes, total and direct bilirubin, iron, and total iron-binding capacity) were analyzed using SPSS software (version 18) and MedCalc software (version 19). A p-value of 0.05 was considered statistically significant. Results: In this study, 68 and 66 participants were male and female, respectively. The mean age of the patients was 24. (44±11).26 years. Pathological examination showed that six patients underwent a negative appendectomy. A positive appendectomy was noted in 128 subjects. Histopathological results confirmed the perforation of the appendix in 78 patients. Among the laboratory tests, only the accuracy of serum iron was fair in the diagnosis of acute appendicitis (AUC numerical value in the ROC curve=0.787). The accuracy of other tests based on the AUC numerical value in the ROC curve was poor or failed. Conclusions: Although the accuracy of serum iron based on the numerical value of AUC in the ROC curve was diagnostically fair for acute appendicitis, it is suggested to carry out further studies with larger sample sizes in order to draw definitive conclusions given the small sample size in this study.

Accuracies of Diagnostic Methods for Acute Appendicitis

2013 ◽  
Vol 79 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Jong Seob Park ◽  
Jin Ho Jeong ◽  
Jong In Lee ◽  
Jong Hoon Lee ◽  
Jea Kun Park ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Physical Examination ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Negative Appendectomy ◽  
Pathologic Findings ◽  
Negative Appendectomy Rate ◽  
Sensitivity Specificity

The objectives were to evaluate the effectiveness of ultrasonography, computed tomography, and physical examination for diagnosing acute appendicitis with analyzing their accuracies and negative appendectomy rates in a clinical rather than research setting. A total of 2763 subjects were enrolled. Sensitivity, specificity, positive predictive value, and negative predictive value and negative appendectomy rate for ultrasonography, computed tomography, and physical examination were calculated. Confirmed positive acute appendicitis was defined based on pathologic findings, and confirmed negative acute appendicitis was defined by pathologic findings as well as on clinical follow-up. Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography were 99.1, 91.7, 96.5, and 97.7 per cent, respectively; for computed tomography, 96.4, 95.4, 95.6, and 96.3 per cent, respectively; and for physical examination, 99.0, 76.1, 88.1, and 97.6 per cent, respectively. The negative appendectomy rate was 5.8 per cent (5.2% in the ultrasonography group, 4.3% in the computed tomography group, and 12.2% in the physical examination group). Ultrasonography/computed tomography should be performed routinely for diagnosis of acute appendicitis. However, in view of its advantages, ultrasonography should be performed first. Also, if the result of a physical examination is negative, imaging studies after physical examination can be unnecessary.

scholarly journals Comparative Study between Neopterin and Alvarado Score in the Diagnosis of Acute Appendicitis and Its Severity

2021 ◽  
Vol 9 (B) ◽  
pp. 42-47
Author(s):  
Zuhair B. Kamal ◽  
Raghad E. Naji ◽  
Hiba A. Ali
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Histopathological Examination ◽  
Perforated Appendicitis ◽  
Signs And Symptoms ◽  
Complex Case ◽  
Control Group ◽  
Negative Appendectomy ◽  
Alvarado Score

BACKGROUND: Acute appendicitis (AA) remains a complex case even for experienced surgeons. Rate of negative appendectomy is 5–40% and delayed intervention result in perforated appendicitis in 5–30% of cases. AIM: The aim of the study was to evaluate NPT as a marker for the diagnosis of AA concerning its severity. And compare the diagnostic value of it with the ALV scoring system. METHODS: One hundred twenty patients presented with signs and symptoms of AA and underwent appendectomy, only 84 patients proved to be AA by histopathological examination, were included in the study. Blood samples for neopterin (NPT) estimation and Alvarado (ALV) score was calculated. Control group consists of 45 healthy individual. RESULTS: NPT levels were significantly higher in patients’ group than control with p = 0.001 at a cutoff point 5.3 nmol/L. The diagnostic accuracy of NPT was higher than ALV score. NPT sensitivity, specificity, positive predictive value, and negative predictive value were 85.4%, 76.9%, 89%, and 70%, respectively. CONCLUSION: NPT significantly elevated in patient with AA and has a high diagnostic accuracy, with correlation to clinical features and severity of the inflammation.

scholarly journals Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(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.

scholarly journals The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications

2013 ◽  
Vol 95 (3) ◽  
pp. 215-221 ◽  
Author(s):  
I G Panagiotopoulou ◽  
D Parashar ◽  
R Lin ◽  
S Antonowicz ◽  
AD Wells ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Cell Count ◽  
Inflammatory Markers ◽  
White Cell Count ◽  
Perforated Appendicitis ◽  
Diagnostic Value ◽  
White Cell ◽  
C Reactive Protein ◽  
Reactive Protein

Introduction Inflammatory markers such as white cell count (WCC) and C-reactive protein (CRP) and, more recently, bilirubin have been used as adjuncts in the diagnosis of appendicitis. The aim of this study was to determine the diagnostic accuracy of the above markers in acute and perforated appendicitis as well as their value in excluding the condition. Methods A retrospective analysis of 1,169 appendicectomies was performed. Patients were grouped according to histological examination of appendicectomy specimens (normal appendix = NA, acute appendicitis = AA, perforated appendicitis = PA) and preoperative laboratory test results were correlated. Receiver operating characteristic (ROC) curve area analysis (area under the curve [AUC]) was performed to examine diagnostic accuracy. Results ROC analysis of all laboratory variables showed that no independent variable was diagnostic for AA. Good diagnostic accuracy was seen for AA when all variables were combined (WCC/CRP/bilirubin combined AUC: 0.8173). In PA, the median CRP level was significantly higher than that of AA (158mg/l vs 30mg, p<0.0001). CRP also showed the highest sensitivity (100%) and negative predictive value (100%) for PA. CRP had the highest diagnostic accuracy in PA (AUC: 0.9322) and this was increased when it was combined with WCC (AUC: 0.9388). Bilirubin added no diagnostic value in PA. Normal levels of WCC, CRP and bilirubin could not rule out appendicitis. Conclusions CRP provides the highest diagnostic accuracy for PA. Bilirubin did not provide any discriminatory value for AA and its complications. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis.

scholarly journals A study to assess the role of raised total leucocyte count in diagnosis of acute appendicitis

2020 ◽  
Vol 7 (10) ◽  
pp. 1541
Author(s):  
Rajesh Kumar ◽  
Renu Chauhan
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Leucocyte Count ◽  
Histopathological Examination ◽  
Perforated Appendicitis ◽  
Cross Sectional Study ◽  
Total Leucocyte Count ◽  
Cross Sectional ◽  
Gandhi Medical College ◽  
Low Sensitivity

Introduction: Total Leucocyte Count (TLC) is an easily available and commonly performed investigation and studies have reported various degrees of leucocytosis in patients with acute appendicitis. This study was performed with the aim to assess the diagnostic validity of raised TLC count in acute appendicitis.Methods: This was a cross sectional study conducted from 2013 to 2015, in the Department of General Surgery, Indira Gandhi Medical College, Shimla. A clinical diagnosis of acute appendicitis was made based on detailed history taking, clinical examination, and laboratory investigations including TLC count. 50 patients with acute appendicitis were enrolled in the study by convenience sampling, after taking a written, informed consent. Appendicectomy specimen were sent for histopathological examination (HPE).Results: The mean age of the patients was 26.48 ± 12.28 years. 29 (58%) patients were male, and 21 (42%) were female. The negative appendicectomy rate in the present study was 14%. 7 (14%) were normal appendices, 31 (62%) inflamed appendices, 4 (8%) perforated appendices, and 8 (16%) gangrenous appendices as per HPE report. In our study, there were 12 (24%) cases of complicated appendicitis i.e., 8 (16%) cases of gangrenous appendicitis and 4 (8%) cases of perforated appendicitis). TLC had a sensitivity 76.74%, specificity 51.14%, positive predictive value 91.66%, and negative predictive value 28.57%.Conclusion: In our study, TLC was found to have low sensitivity and specificity for acute appendicitis. Hence, used alone, TLC may not be diagnostic of acute appendicitis. However, used in conjunction with other laboratory parameters, it will lead to improvement of diagnostic accuracy.

Diagnostic Performance and Reliability of the Standardized Computed Tomography Reporting System for Acute Appendicitis: Experience in a Tertiary Care Academic Center

2021 ◽  
Vol 104 (7) ◽  
pp. 1102-1108
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Interobserver Agreement ◽  
Reporting System ◽  
Lower Quadrant ◽  
Suspected Appendicitis ◽  
Diagnostic Certainty

Background: Computed tomography (CT) is generally accepted as a modality of choice for imaging workup in patients with suspected appendicitis. A standardized CT reporting system, CT certainty score, has been proposed to improve diagnostic accuracy and to reduce ambiguous CT reports. Objective: To assess the diagnostic performance and the reliability of the standardized CT reporting system for acute appendicitis in Thai adults. Materials and Methods: The present study was a retrospective data review of 421 adult patients who had CT scans of the appendix between January 2016 and December 2017. The clinical and imaging data were extracted and analyzed. The pathological result was used as a standard of reference. The diagnostic performance and interobserver agreement of the standardized CT reporting system were estimated. Results: One hundred sixty-three patients, with a mean age of 41.7 years, had clinical diagnoses of acute appendicitis. Using standardized CT report, radiologists were highly accurate at diagnosing appendicitis [area under curve (AUC) 0.988 (95% CI 0.98 to 1.00); p<0.001]. The estimated sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.1% (95% CI 90.6 to 97.9), 95.7% (95% CI 92.5 to 97.9), 93.4% (95% CI 88.7 to 96.2), 96.9% (95% CI 93.0 to 97.2), 95.5% (95% CI 93.0 to 97.3), respectively. The interobserver agreement was greater than 80% for all binary objective findings and more than 90% agreement on the presence or absence of greater-than-3-mm wall thickness, appendicolith, periappendiceal air, and right lower quadrant fluid collection. The use of CT certainty score had interobserver agreement of 78% (κ=0.69; 95% CI 0.62 to 0.77). Conclusion: Using a standardized CT reporting system yielded a high diagnostic accuracy and high reproducibility of supportive CT findings for appendicitis in at-risk patients. The standardized CT reporting system can improve diagnostic certainty, accuracy, and guide patient management. Keywords: Appendicitis; Certainty score; Computed tomography; Standardized reporting system

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

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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