The role of rebound tenderness in acute appendicitis and appendicular perforation

Background: Acute appendicitis is the most common surgical emergency. Inspite of sophisticated new investigations mainstay of diagnosis depends on clinical sign and symptoms, rebound tenderness is very important sign with controversial views regarding it in available literature. Hence this study was undertaken to prove its efficacy of it related to rule out appendicular perforations.Methods: This study was conducted in 418 patients with 186 female and 251 male. Patients were of acute appendicitis operated for appendicectomy were included in the study. Data analysis was done by data statistic software.Results: The sensitivity and specificity of rebound tenderness to diagnose acute appendicitis is 65% and 73.6% respectively whereas the sensitivity and specificity of rebound tenderness to diagnose appendicular perforation was 94% and23.3% respectively with positive predictive value is 5 and negative predictive value is 99.Conclusions: Hence it indicates that rebound tenderness is very important to rule out complications like perforation or peritonitis and to support diagnosis of acute appendicitis. It has minimal significance to diagnose perforation of appendix as positive predictive value is less.

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Sherren`s triangle hyperaesthesia a tool to rule out complicated appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20182774 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2563

Author(s):

Yashwant R. Lamture ◽

Harshal Ramteke ◽

Varsha Gajbhiye

Keyword(s):

Data Analysis ◽

Acute Appendicitis ◽

Clinical Sign ◽

Sensitivity And Specificity ◽

Study Data ◽

Complicated Appendicitis ◽

Predictive Values ◽

Surgical Emergency ◽

Important Sign ◽

Rule Out

Background: Acute appendicitis is the most common surgical emergency. In spite of sophisticated new investigations mainstay of diagnosis depends on clinical sign and symptoms, Sherren`s triangle hyperaesthesia is very important sign with controversial efficacy about it in available literature. Hence this study was undertaken to prove its efficacy of it.Methods: This study was conducted in 418 patients with 186 females and 251 males. Patients were of acute appendicitis operated for appendicectomy included in the study. Data analysis was done by data statistic software.Results: Sensitivity and specificity of hyperaesthesia in Sherren’s triangle were 47.7% and 42.9% respectively with positive and negative predictive values were 92.1% and 5.56%.Conclusions: Hence it indicates that hyperaesthesia in Sherren’s triangle is important sign to suspect to support diagnosis of acute appendicitis. It has minimal significance to rule out it. This sign plays very important role in a diagnosis of complicated appendicitis like obstructive appendicitis.

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Raja Isteri Pengiran Anak Saleha Appendicitis score for the diagnosis of acute appendicitis in comparison with the Alvarado score

International Surgery Journal ◽

10.18203/2349-2902.isj20200298 ◽

2020 ◽

Vol 7 (2) ◽

pp. 459

Author(s):

Mannem G. K. Reddy ◽

V. Mahidhar Reddy

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Scoring Systems ◽

Signs And Symptoms ◽

College Hospital ◽

Alvarado Score ◽

Threshold Point ◽

Ripasa Score

Background: Different scoring systems have been created to increase diagnostic accuracy, and they are inexpensive, non-invasive, and easy to use and reproduce. The modified Alvarado score is widely used in emergency services. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score was formulated in 2010 and has greater sensitivity and specificity. The aim of our article was to compare the usefulness of modified RIPASA score and Alvarado score in the diagnosis of patients with abdominal pain and suspected acute appendicitis.Methods: A prospective study was undertaken among 100 cases presenting with signs and symptoms suggestive of acute appendicitis, conducted at the Narayana medical college hospital, Nellore. The questionnaires used for the evaluation process were applied to the patients suspected of having appendicitis.Results: A total of 100 patients, 95% underwent laparoscopic procedure. The cut-off threshold point of the Alvarado score was set at 7.0, which yielded a sensitivity of 65% and a specificity of 52%. The positive predictive value was 65%. The cut-off threshold point of the modified RIPASA score was set at 7.5, which yielded 90% sensitivity and 72% specificity. The positive predictive value was 89% and the NPV was 30%.Conclusions: On comparing both the scores, sensitivity and specificity was higher for modified RIPASA score. The positive predictive value was higher for the Alvarado and negative predictive value was higher for RIPASA score. Bothe p values were statistically significant.

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ACUTE APPENDICITIS

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.12.845 ◽

2015 ◽

Vol 22 (12) ◽

pp. 1601-1605

Author(s):

Khawar Saeed Jamali ◽

Humaid Ahmed ◽

Muhammad Jawed ◽

Ubedullah Shaikh

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Predictive Value ◽

Cross Sectional Study ◽

Inclusion Criteria ◽

Cross Sectional ◽

Group A ◽

Male Patients ◽

The Mean ◽

Group B

Objectives: The objective of this study was to compare the efficacy of ClinicalEvaluation and modified Alvarado scoring system in diagnosing acute appendicitis. StudyDesign: Cross sectional study. Place and Duration of Study: This study was conducted atSurgical Unit III of Civil Hospital Karachi from May 2010 to October 2010. Methodology: Thisstudy consisted of eighty patients. Patients were divided in two groups. Group A for completeclinical evaluation comprising of 40 patients and Group B for modified Alvarado scoring systemcomprising of 40 patients. Inclusion criteria were all patients presenting with RIF pain, nausea,vomiting, fever and/or anorexia, diagnosed as having acute appendicitis preoperatively andundergoing emergency appendectomy during this period, age >12 years and both gender.Exclusion criteria included not willing for surgery, General anesthesia problem, pregnant femalepatients and those who did not give written consent. Results: A total of 80 patients were includedin the study, placed alternatively into two groups of 40 patients each with majority being male(n = 61, 76.3%). The mean age was 22.46 years. The positive predictive value for patients ofGroup A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared onthe basis of Gender for the two groups, the positive predictive value for male patients of GroupA and B was 90.09% and 89.28% respectively, but for females the positive predictive valueof Group A and B was 100% and 50% respectively. Conclusion: We conclude that modifiedAlvarado score can be used safely and effectively in diagnosing acute appendicitis in adultmales especially as the score increases from seven to nine.

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EVALUATION OF ACUTE APPENDICITIS USING ULTRASOUND

International Journal of Advanced Research ◽

10.21474/ijar01/12449 ◽

2021 ◽

Vol 9 (02) ◽

pp. 315-321

Author(s):

Abdullah Hamdan ◽

◽

Nasraldeen Alnaeem M. Alkhidir ◽

Abdelmoneim Saeed ◽

◽

...

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Clinical Diagnosis ◽

Predictive Value ◽

Sensitivity Specificity ◽

Histopathological Report

The diagnosis of acute appendicitis is mainly clinical and to confirm the clinical diagnosis ultrasonography (USG) of the abdomen is being used to help in diagnosis of the disease. To find out the role of USG in the diagnosis of acute appendicitis in clinically equivocal cases and to correlate USG findings with histopathological reports (HPR) of removed appendix.Total numbers of 100 patients were included in the study from 12March 2019 to 5 December 2019. Findings on ultrasound were finally compared with histopathological report of appendices removed on surgery. Those cases with alternate diagnosis were followed up and proved with other means of investigation. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of ultrasound in diagnosis of acute appendicitis in our study were found to be 79 %, 84.20 %, 95.50%, 48.40% and 80% respectively.

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Clinicopathological evaluation of acute appendicitis and the role of ultrasound in diagnosis: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20191560 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1471

Author(s):

Tony Mathew ◽

Amit Shivshankar Ammanagi

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Prospective Study ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Lower Abdominal Pain ◽

Negative Appendicectomy ◽

A Prospective Study

Background: Acute appendicitis is the most common acute surgical condition of the abdomen. Delay in treatment of acute appendicitis causes lot of complication. Study was done with the objective to study the clinical and pathological presentations of acute appendicitis, to evaluate the role of ultrasound in early diagnosis of acute appendicitis and to reduce negative appendicectomy in patients.Methods: This is a prospective study done on 100 patients with acute right lower abdominal pain clinically presumed to be of appendicular origin. A thorough history, clinical examination and ultrasound scan, was done for all cases. All ultrasound positive cases were subjected to surgery and some negative cases were also taken for surgery based on clinical suspicion. The ultrasound diagnosis was compared with clinical findings, operative findings and histopathological examination reports.Results: The overall accuracy of clinical diagnosis (Alvarado scoring system) with histopathology findings was 72%. The overall sensitivity and specificity was 70.3% and 81.3% respectively and positive predictive value of was 95.2% whereas the negative predictive value was 34.2%. The overall accuracy of ultrasound with histopathology report was 93%, with a sensitivity of 96.4%, specificity of 75%, and a positive predictive value of 95% and a negative predictive value of 80%. Negative appendicectomy rate was 8.82% in females and 3.63% in males.Conclusions: The Alvarado scoring system combined with ultrasound can therefore be used as a cheap and inexpensive way of confirming acute appendicitis thus reducing negative appendicectomy rate.

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A Study to Evaluate the Significance of Sherren’s Triangle Hyperaesthesia in a Treatment of Acute Appendicitis

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.3 ◽

2020 ◽

Vol 3 (1) ◽

pp. 12-15

Author(s):

Amarnath Gupta ◽

A P Singh

Keyword(s):

Acute Appendicitis ◽

Clinical Sign ◽

Sensitivity And Specificity ◽

Complicated Appendicitis ◽

Predictive Values ◽

Surgical Emergency ◽

Study Results ◽

Important Sign ◽

Rule Out

Background: Acute appendicitis is the most common surgical emergency. In spite of sophisticated new investigations mainstay of diagnosis depends on clinical sign and symptoms, Sherren‘s triangle hyperaesthesia is very important sign with controversial efficacy about it in available literature. The aim of this study was to explore the significance of hyperaesthesia in Sherren’s triangle in a treatment of acute appendicitis. Subjects and Methods: This study was conducted in 418 patients with 186 females and 251 males. Patients were of acute appendicitis operated for appendicectomy included in the study. Results: Sensitivity and specificity of hyperaesthesia in Sherren’s triangle were 47.7% and 42.9% respectively with positive and negative predictive values were 92.1% and 5.56%. Conclusion: Hence it indicates that hyperaesthesia in Sherren’s triangle is important sign to suspect to support diagnosis of acute appendicitis. It has minimal significance to rule out it. This sign plays very important role in a diagnosis of complicated appendicitis like obstructive appendicitis.

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The role of ultrasonography in acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20171637 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1769

Author(s):

Yashwant R. Lamture ◽

Varsha P. Gajbhiye ◽

Vinay V. Shahapurkar

Keyword(s):

Data Analysis ◽

Acute Appendicitis ◽

Crucial Role ◽

Study Data ◽

Normal Appendix ◽

Chronic Appendicitis ◽

Expert Radiologist ◽

Negative Appendicectomy ◽

Rule Out

Background:Acute appendicitis is the most common surgical emergency. Inspite of new investigations, mainstay of diagnosis depends on clinical sign and symptoms, laboratory and USG (ultrasonography) of abdomen. Out all these investigations USG is having a crucial role in a diagnosis of it. Hence this study was undertaken to prove its efficacy.Methods: This study was conducted in 418 patients with 186 females and 251 males. Patients were of acute appendicitis operated for appendicectomy were included in the study. Data analysis was done by Stata statistic software. Before surgery patients were subjected for necessary investigations including USG.Results:The mean age was 18.8 (range 8-83) years. Normal appendix found in 22 cases, hence negative appendicectomy rate was 6.6%. Chronic appendicitis was found in 28 patients. Different pathology was found in 1 in the form of carcinoid of appendix (0.24%) but treated by appendicectomy. USG abdomen in present study showed sensitivity of 88.6% and specificity 92% with PPV and NPV was 98% and 52.3%, frequency reports were s/o acute appendicitis in 337 patients and normal in 82 subjects.Conclusions:It conclude that USG is very important tool to diagnose and rule out appendicitis and its complications like perforation or peritonitis. Its liberal use by expert radiologist can help to reduce negative appendicectomy rate.

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Comparison between AIR score and Alvarado score in cases of non-perforated and perforated acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20191028 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1108

Author(s):

Debabrata Gope ◽

Anuradha Santosh Dnayanmote ◽

Saurav Mahesh Thakkar ◽

Akriti Rajkumar Tulsian ◽

Shweta Achuthan Kutty ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Positive Predictive Value ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Acute Abdominal Pain ◽

Pathological Examination ◽

Alvarado Score ◽

Sensitivity Specificity ◽

Higher Sensitivity

Background: Acute abdominal pain is a common complaint in the emergency department. Diagnostics of one of the most common pathologies behind acute abdominal pain, acute appendicitis, has radically changed over the last decades. There are several different diagnostic scores for suspected acute appendicitis. The Alvarado score being most widely known. Appendicitis Inflammatory Response (AIR) score was designed to overcome drawbacks of previous scores. This score incorporated the C-reactive protein value in its design and was developed and validated on a prospective cohort of patients with suspicion of acute appendicitis.Methods: Patients with pain in RIF were admitted. Scores were assessed, patients whose score was significant by either of the system were subjected for appendicectomy. The specimens of appendix were sent for histo-pathological examination (HPE). Post-operative histopathology report was correlated with the scores. Sensitivity, specificity, positive predictive value and negative predictive for AIR and Alvarado score were calculated.Results: For scores >4, AIR score has higher sensitivity and specificity. The negative predictive value (NPV) of AIR score was higher and the positive predictive value (PPV) of AIR score was also high. For scores >8, Alvarado score has higher sensitivity as compared to AIR score whereas AIR score has higher specificity as compared to Alvarado score. NPV of Alvarado score was higher while PPV of AIR score was higher.Conclusions: In this study AIR score had Alvarado score displaying higher sensitivity and specificity.

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Role of diffusion-weighted magnetic resonance imaging in assessment of mammographically detected asymmetric densities

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00361-5 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Mohamed Zidan ◽

Shimaa Ali Saad ◽

Eman Abo Elhamd ◽

Hosam Eldin Galal ◽

Reem Elkady

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Benign Lesions ◽

Adc Value ◽

Dce Mri ◽

Diffusion Weighted ◽

Breast Asymmetries ◽

Malignant Lesions

Abstract Background Asymmetric breast density is a potentially perplexing finding; it may be due to normal hormonal variation of the parenchymal pattern and summation artifact or it may indicate an underlying true pathology. The current study aimed to identify the role of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) values in the assessment of breast asymmetries. Results Fifty breast lesions were detected corresponding to the mammographic asymmetry. There were 35 (70%) benign lesions and 15 (30%) malignant lesions. The mean ADC value was 1.59 ± 0.4 × 10–3 mm2/s for benign lesions and 0.82 ± 0.3 × 10–3 mm2/s for malignant lesions. The ADC cutoff value to differentiate between benign and malignant lesions was 1.10 × 10–3 mm2/s with sensitivity 80%, specificity 88.6%, positive predictive value 75%, negative predictive value 91%, and accuracy 86%. Best results were achieved by implementation of the combined DCE-MRI and DWI protocol, with sensitivity 93.3%, specificity 94.3%, positive predictive value 87.5%, negative predictive value 97.1%, and accuracy 94%. Conclusion Dynamic contrast-enhanced MRI (DCE-MRI) was the most sensitive method for the detection of the underlying malignant pathology of breast asymmetries. However, it provided a limited specificity that may cause improper final BIRADS classification and may increase the unnecessary invasive procedures. DWI was used as an adjunctive method to DCE-MRI that maintained high sensitivity and increased specificity and the overall diagnostic accuracy of breast MRI examination. Best results can be achieved by the combined protocol of DCE-MRI and DWI.

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The Association of “GOOP” on Gross Examination of Fine Needle Aspiration Samples and On-Site Adequacy

Respiration ◽

10.1159/000517923 ◽

2021 ◽

pp. 1-4

Author(s):

Nikhil Meena ◽

Thaddeus Bartter ◽

Roshen Mathew ◽

Abhishek Kumar ◽

Winnie Elma Roy ◽

...

Keyword(s):

Positive Predictive Value ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Needle Aspiration ◽

Fine Needle ◽

Study Interval ◽

White Material ◽

Gross Examination ◽

Malignant Diagnosis ◽

Rule Out

Background: Rapid on-site cytologic evaluation (ROSE) is not always available for fine needle aspiration (FNA) specimens. We have examined the relationships between the presence of “GOOP” (defined as gooey white material) on FNA aspirates, on-site adequacy (OSA), and diagnosis. Methods: Consecutive FNA samples obtained over the study interval were included. Samples were assessed macroscopically for the presence or absence of GOOP (GOOP+ or GOOP−). GOOP+ samples were further characterized as shiny (G+S) or cheesy (G+C). Gross descriptors were correlated with OSA and final diagnoses. Results: Of the 204 sites biopsied, 102 were malignant, 94 benign, and 8 nondiagnostic. The presence of GOOP was highly predictive for adequacy (positive predictive value 98%). While these correlations for GOOP positivity were significant, the absence of GOOP did not rule out adequacy or malignancy. The presence of GOOP was also significantly correlated with a malignant diagnosis. Conclusions: We have prospectively demonstrated that the presence of GOOP correlates strongly with adequacy. This may be of value for those for whom ROSE is not available and, when available, may help prioritize specimens for on-site review.

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