scholarly journals Negative laparotomy rates in acute abdomen: a declining trend

2016 ◽  
Vol 4 (1) ◽  
pp. 323 ◽  
Author(s):  
Geeta Sabhnani ◽  
Shreya Tomar
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Acute Abdomen ◽  
Common Finding ◽  
Emergency Setting ◽  
X Ray ◽  
Negative Laparotomy ◽  
Preoperative Diagnostic ◽  
Operative Findings ◽  
Accuracy Rates

Background:A prospective observational study of 105 operated cases of non-traumatic acute abdomen in emergency setting in tertiary government hospital was carried out. The correlation between preoperative diagnostic, radiological and clinical assessment and operative findings was noted. The clinical and radiological diagnostic accuracy rates were calculated using descriptive statistical analysis. Negative laparotomy rates were calculated and compared to the previous studies.Methods: The most common finding was acute appendicitis and the most frequently involved age group was 21-40.The absence of correlation between preoperative diagnosis and operative findings was noted in 7 cases of which 2 cases of appendicitis had been missed on ultrasound and 2 cases of appendicular mass were reported as acute appendicitis where appendectomy could not be done on account of adhesions.2 cases of x-ray diagnosed obstruction with clinical features of vomiting ,constipation had no gross bowel pathology on laparotomy while one case diagnosed preoperatively as appendicitis turned out to be a case of renal colic with hydroureter.Results:The diagnostic accuracy rate of x-ray and ultrasound for obstruction/perforation and acute appendicitis were found to be 89.79% and 94.64% respectively.Conclusions:The negative laparotomy rates were low around 2.85%.

scholarly journals Clinico-pathological and etiological evaluation of acute appendicitis and assessment of significance of laboratory and ultrasonography examination as an ancillary aid to clinical diagnosis

2019 ◽  
Vol 6 (6) ◽  
pp. 1954
Author(s):  
Sailendra Nath Paul ◽  
Dilip Kumar Das
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Clinical Symptoms ◽  
Lower Abdominal Pain ◽  
Complication Rates ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Operative Findings

Background: Timely diagnosis and intervention of acute appendicitis reduces morbidity and mortality associated with the disease condition. The study aimed to evaluate the etiology of acute appendicitis, to analyze the sensitivity of modified Alvarado scoring system and radiology in the diagnosis of acute appendicitis and to correlate the observations of laboratory tests, operative findings with the histopathological report of specimen of appendix.Methods: This was a prospective study done on 100 patients with clinical symptoms of acute right lower abdominal pain suggestive of appendicular origin during the period from February 2015 to January 2016 in the department of surgery thorough clinical assessment, laboratory investigations, ultrasound findings as were done for all patients. After confirming the diagnosis of AA the patients had operative intervention and specimens were sent for histopathological study.Results: Male preponderance was seen in the study. Majority of them belongs to 21 to 30 years age group (50%). Faecolith was the most common etiological factor observed (58%). Abdominal pain (100%) was the most common clinical symptom. Alvarado score had sensitivity of 95.74% and specificity of 66.67% in diagnosing AA. In correlation to histopathological findings, ultrasonography findings showed 100% positive visualization rate in all 71 cases. Elevated ESR (94%) had high diagnostic accuracy as confirmed by HPE finding (96.81%) which is statistically significant (p<0.000).Conclusions: Alvarado scoring system, elevated ESR levels and USG findings of the appendix can be considered as adjuncts to clinically diagnose the AA, to improve the diagnostic accuracy thereby consequently the rate of negative appendicectomy can be reduced and thus decreases the complication rates.

scholarly journals Diagnostic accuracy of ultrasound in common acute abdominal conditions

2019 ◽  
Vol 6 (12) ◽  
pp. 4460
Author(s):  
Shashank Deshmukh ◽  
A. Manmadha Kishan
Keyword(s):  
Acute Pancreatitis ◽  
Acute Appendicitis ◽  
Intestinal Obstruction ◽  
Diagnostic Accuracy ◽  
Acute Intestinal Obstruction ◽  
Ct Findings ◽  
Perforation Peritonitis ◽  
Good For ◽  
Operative Findings ◽  
Acute Perforation

Background: Ultrasound evaluation is cheap, easily available, even at rural level, and can predict need for surgical intervention in majority of conditions. It involves no exposure to radiation, can diagnose easily, can be repeated any number of times for follow up. Disadvantages are that it is user dependent and distended bowel containing air prevents satisfactory evaluation of abdomen. The objective was to study diagnostic accuracy of ultrasound in common acute abdominal conditions.Methods: All patients presenting to the emergency Department of General Surgery, Narayana general hospital, Nellore with abdominal pain of acute onset and who were diagnosed to be suffering from acute appendicitis, acute perforation peritonitis, acute intestinal obstruction, acute pancreatitis, acute calculous cholecystitis were included in the present study.Results: Diagnostic accuracy of USG for acute appendicitis was little bit low with sensitivity of 71.8% and specificity of 59.1% for operative findings and similar for CT findings. For acute perforation peritonitis it was still very low with sensitivity of 42.9% and specificity of 66.7% for operative findings and similar for CT findings. It was very good for acute intestinal obstruction with sensitivity of 90.9% and specificity of 83.3%, but here it was low compared to CT findings. It was also pretty good for diagnosing acute calculus cholecystitis in comparison with operative as well as CT findings.Conclusions: USG can be used as a diagnostic tool for diagnosis of acute intestinal obstruction and acute calculus cholecystitis but doubtful role in the diagnosis of acute appendicitis and acute perforation peritonitis and acute pancreatitis. 

scholarly journals ACUTE APPENDICITIS;

2014 ◽  
Vol 21 (06) ◽  
pp. 1139-1143
Author(s):  
Zahid Saeed
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Acute Abdomen ◽  
Carcinoid Tumour ◽  
Diagnostic Tools ◽  
Associated Conditions ◽  
Proper Diagnosis ◽  
Negative Appendicectomy ◽  
Appendiceal Inflammation ◽  
Time Of Presentation

Background: Acute appendicitis is the commonest cause of acute abdomen presenting in emergency room, which is mainly diagnosed on clinical grounds. Objective: To determine the diagnostic accuracy in patient of acute appendicitis and to review the pathological diagnosis. Material and Method: A retrospective study was conducted at PNS SHIFA hospital at Karachi; from May 2012 to April 2013. A total of 120 patients were included in the study who presented with acute abdomen and clinically diagnosed as acute appendicitis. Emergency appendectomy was done in all consecutive subjects and intra operative finding along with histo-pathological reports were compared with clinical diagnosis. Results: A total of 120 patients were included in the study who underwent appendicectomy during this period. The majority of our patients were in the age group between 15-30 years (66.5%) and presented within 24 h of onset of symptoms. The most common symptoms were abdominal pain (100%), vomiting (57.4%) and anorexia (49.0%). Pyrexia was noted in 41.0%.Localized abdominal tenderness with positive release sign was mainly present. The most common incision was gridiron (57.2%) followed by Lanz (37.3%) and in remaining Rutherford Morrison incision was made. Acute appendiceal inflammation and gangrenous appendicitis was present in 67% and 13%, respectively. The perforation rate was 5.0% and there was a direct correlation with time of presentation. There were no patients with carcinoid tumour or adenocarcinoma. Parasites and other associated conditions were seen in 3 % of cases. On the basis of histo-pathological report, 84% were found to have acute appendicitis with negative appendicectomy rate of 16.0%. Conclusions: Clinical surgical skill is good enough to diagnose acute appendicitis but auxiliary diagnostic tools can help to elevate the diagnostic accuracy,but these are not 100% accurate and at times may not be available.So clinial good judgement is essential for proper diagnosis and that can be confirmed by histopathology report.

scholarly journals Improving the Preoperative Diagnostic Accuracy of Acute Appendicitis. Can Fecal Calprotectin Be Helpful?

PLoS ONE ◽  
2016 ◽  
Vol 11 (12) ◽  
pp. e0168769 ◽  
Author(s):  
Peter C. Ambe ◽  
Valerie Orth ◽  
Daniel Gödde ◽  
Hubert Zirngibl
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Fecal Calprotectin ◽  
Preoperative Diagnostic

scholarly journals Diagnosis and Treatment of Mucinous Appendiceal Neoplasm Presented as Acute Appendicitis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Ioannis Kehagias ◽  
Apollon Zygomalas ◽  
Georgios Markopoulos ◽  
Thanasis Papandreou ◽  
Pantelis Kraniotis
Keyword(s):  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Histopathological Examination ◽  
Fluid Collection ◽  
Laparoscopic Approach ◽  
Low Grade ◽  
Emergency Setting ◽  
Cytologic Examination ◽  
Appendiceal Neoplasm ◽  
Appendiceal Mucocele

Appendiceal mucocele is a rare cause of acute abdomen. Mucinous appendiceal neoplasms represent 0.2–0.7% of all appendix specimens. The aim of this study is to report a case of a mucinous appendiceal neoplasm presented as acute appendicitis, discussing the clinical and surgical approach in the emergency setting. A 72-year-old female patient was admitted to the emergency department with a clinical examination indicative of acute abdomen. The patient underwent abdominal computed tomography scan which revealed a cystic lesion in the right iliac fossa measuring 8.3 × 5.2 × 4.1 cm, with calcified walls, and a mean density indicative of high protein content. The patient was taken to the operating room and a right hemicolectomy was performed. The postoperative course was unremarkable. The histopathological examination revealed a low-grade mucinous appendiceal neoplasm with negative regional lymph nodes. Ultrasound and CT are useful in diagnosing appendiceal mucocele and synchronous cancers in the emergency setting. The initial operation should include appendectomy and resection of the appendicular mesenteric fat along with any fluid collection for cytologic examination. During urgent appendectomy it is important to consider every mucocele as malignant in order to avoid iatrogenic perforation causing pseudomyxoma peritonei. Although laparotomy is recommended, the laparoscopic approach is not contraindicated.

scholarly journals EVALUATION OF PREOPERATIVE DIAGNOSTIC ACCURACY OF MODIFIED ALVARADO SCORING SYSTEM IN ACUTE APPENDICITIS

2018 ◽  
Vol 7 (28) ◽  
pp. 3253-3256
Author(s):  
Yamuna V. S ◽  
Jagannath Jagannath ◽  
Kirankumar K. M ◽  
Ved Prakash Ranjan ◽  
Karthik P
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Preoperative Diagnostic

scholarly journals ACUTE ABDOMEN;

2008 ◽  
Vol 15 (01) ◽  
pp. 120-124
Author(s):  
MUHAMMAD ASIF ◽  
JAVED SAJJAD HASHMI ◽  
DANISH ALMAS
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Diagnostic Tools ◽  
Military Hospital ◽  
Child Bearing ◽  
Common Causes ◽  
Preoperative Diagnostic ◽  
Postoperative Diagnosis ◽  
Abdominal Disorder

Introduction: The term “acute abdomen” denotes any sudden spontaneousnon-traumatic disorder whose chief manifestation is in the abdominal area. There is frequently a progressive underlyingintra-abdominal disorder, the correct early diagnosis and treatment of which is essential for a favorable outcome.Objectives: (I) To find out the most common causes of acute abdomen. (II) To compare the preoperative assessmentwith postoperative diagnosis. Design: A Non-interventional Analytical (Comparative) study. Setting: Emergencydepartment of Combined Military Hospital Kharian. Period: Oct 2001 to Mar 2002. Patients & Methods: Total of 220patients who presented with acute abdomen. Results: The most frequent cause was found to be Acute Appendicitis,followed by Nonspecific abdominal pain, acute cholecystitis, acute intestinal obstruction and perforated duodenal ulcer.Preoperative diagnosis was wrong in 9.5% (n=21) of cases. Conclusion: Acute appendicitis was found to be the mostcommon cause of acute abdomen and the single most important cause of acute abdominal pain causing greatdiagnostic difficulties. the preoperative diagnostic accuracy can be increased especially in female of child bearing ageby using modern diagnostic tools especially laparoscopy.

Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard?

2020 ◽  
Vol 13 (4) ◽  
pp. 184-190
Author(s):  
Muhammad Irfan ◽  
Abdul Rasheed Qureshi ◽  
Zeeshan Ashraf ◽  
Muhammad Amjad Ramzan ◽  
Tehmina Naeem ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Gold Standard ◽  
Pleural Effusions ◽  
Diagnostic Efficacy ◽  
Chest Sonography ◽  
X Ray ◽  
Non Invasive ◽  
Fluid Detection

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available  and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard.   Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology  OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

Utility of RDW in Prediction of Strangulation in Emergency Setting Hernias

2015 ◽  
Vol 100 (9-10) ◽  
pp. 1262-1264
Author(s):  
Okan Akturk ◽  
Baris Dogu Yildiz ◽  
Melih Karabeyoglu ◽  
Isıl Karabeyoglu
Keyword(s):  
Intestinal Ischemia ◽  
Surgical Intervention ◽  
Serum Markers ◽  
Emergency Setting ◽  
Red Cell ◽  
Cell Distribution ◽  
Blood Cell Count ◽  
Distribution Width ◽  
Abdominal Hernias ◽  
Operative Findings

Most of the small bowel obstruction cases are due to adhesions and hernias. Identifying strangulated cases may save patients from consequences of unnecessary operations and save patients who need urgent intervention by early detection. Serum markers of intestinal ischemia may help to identify and detect strangulation. The aim of this study was to identify if certain blood values such as RDW can accurately predict presence of strangulation preoperatively. We reviewed files of 127 patients who were operated because of incarcerated abdominal hernias for serum biomarkers and evaluated them with the operative findings. Our results show that elevation in red cell distribution width and white blood cell count may reflect strangulation. These findings may be useful in identifying the strangulated cases that need urgent surgical intervention.

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