Does Serum Bilirubin Add Value in the Diagnosis of Appendicitis? A Multi-Institution Analysis of 2024 Patients

Abstract BACKGROUNDEven with modern diagnostics, appendicitis can be difficult to diagnose accurately. Negative appendicectomies (NA) and delayed diagnosis of complicated appendicitis (CA, i.e. perforation or abscess) remain common. Serum bilirubin has been proposed as an additional biomarker to assist with the diagnosis of appendicitis. In this large series, we assessed the value of bilirubin in the diagnosis of appendicitis.METHODS A retrospective review of patients with suspected appendicitis at three hospitals over a three year period was performed. All consecutive patients with appendicectomy were included. In addition, a “discharged” sub-group of consecutive patients who were admitted with suspected appendicitis but discharged without an operation was also identified.Demographic data, presence of fever, tachycardia, total white cell count (WCC), neutrophil count, total serum bilirubin, operative findings and final histology were recorded. Multivariate logistic regression was performed to determine independent predictors of appendicitis and CA. Receiver-operator analysis was performed to compare bilirubin to WCC and neutrophil count.RESULTS There were 2024 patients: 1167 had uncomplicated appendicitis, 355 had CA and 303 underwent NA. 200 non-surgical "discharged" patients were included for comparison. Compared to those without appendicitis (NA and discharged groups), increased serum bilirubin was associated with an increased likelihood of appendicitis (OR 1.030 (1.013, 1.048), p<0.0001) and increased likelihood of CA (OR 1.035, 95% CI (1.021, 1.050), p<0.001). These results remained significant when the discharged group, NA group and uncomplicated appendicitis groups were analyzed separately.The sensitivity and specificity of bilirubin was inferior to neutrophil count for the diagnosis of appendicitis (AUC 0.657 versus 0.725, p<0.0001). Bilirubin, WCC and neutrophils each were all relatively insensitive and non-specific over a variety of cut-off values and combinations did not improve their accuracy.CONCLUSION Hyperbilirubinaemia was independently associated with an increased likelihood of both uncomplicated and complicated appendicitis, however had similar sensitivity and specificity when compared to WCC or neutrophils. Bilirubin, neutrophil count and WCC alone are not discriminatory enough to be used in isolation but may be incrementally useful adjuncts in pre-operative assessment of patients with suspected appendicitis.

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Evaluation of Serum Bilirubin as a Predictive Marker for Simple and Complicated Appendicitis in Sulaimani Emergency Teaching Hospital

Kurdistan Journal of Applied Research ◽

10.24017/science.2018.2.3 ◽

2018 ◽

pp. 15-20

Author(s):

Seerwan Hama Shareef ◽

Dara Ahmed Mohammed ◽

Goran Ameer Ahmed

Keyword(s):

Acute Appendicitis ◽

Prospective Study ◽

Teaching Hospital ◽

Serum Bilirubin ◽

Complicated Appendicitis ◽

White Blood Count ◽

Total Serum ◽

Lower Sensitivity ◽

Specific Marker ◽

Suspected Appendicitis

Diagnosis of acute appendicitis can be challenging in some cases as the differentials can be exhaustive. Previous studies have demonstrated that hyperbilirubinemia is a more specific marker for appendicitis than white blood count (WBC) and C-reactive protein (CRP), but this investigation is still not commonly used in the diagnostic workup of appendicitis. This prospective study aims to evaluate serum bilirubin as a laboratory marker for simple and complicated appendicitis. We also investigated the diagnostic value of bilirubin in acute appendicitis and compared it with the WBC. In this prospective study, all patients who underwent appendicectomy at the Sulaimani Emergency Teaching Hospital between 1st November 2016 to 1st January 2017 were included. Preoperative total serum bilirubin was measured and compared with the final histopathology report. Patients were divided into 3 groups: non-inflamed appendix, simple appendicitis and complicated appendicitis. One hundred and 75 patients were analysed, 90 of them were females and 85 were males. Hyperbilirubinemia was found in 63% of patients with complicated appendicitis (p=0.001). Mean of bilirubin was significantly different between patients with complicated appendicitis and non-complicated appendicitis (1.101 vs 0.75 mg/dl; p= 0.0017). Bilirubin had a higher specificity (85%) than WBC (36%), but a lower sensitivity (63% vs 89%) for differentiating complicated appendicitis. Patients with suggestive features of acute appendicitis and raised serum bilirubin indicate a complicated case requiring early intervention to prevent peritonitis and septicaemia. Hyperbilirubinemia is a good indicator for complicated appendicitis and serum bilirubin measurement can be included in the work up of patients with suspected appendicitis.

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Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study

International Surgery Journal ◽

10.18203/2349-2902.isj20171138 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1341 ◽

Cited By ~ 1

Author(s):

Sadhan Kumar Cheekuri ◽

Alok Mohanty ◽

T. Ganesh ◽

R. Kannan ◽

Robinson Smile

Keyword(s):

Observational Study ◽

Acute Appendicitis ◽

Serum Bilirubin ◽

Clinical Signs ◽

Signs And Symptoms ◽

Complicated Appendicitis ◽

Total Serum ◽

P Value ◽

Predictive Capacity ◽

Computed Tomography Scanning

Background: Appendicitis is the most common acute abdominal condition requiring emergency surgery, with a lifetime risk of 6%. Appendectomy continues to be one of the commonest procedures in general surgery, accounts for approximately 1% of all surgical operation. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%). The aim of this study was to whether Serum Bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about complicated appendicitis.Methods: This was prospective observational study done in Mahatma Gandhi Medical College and Research Institute, Pondicherry between November 2014 and August 2016. About 110 patients of acute appendicitis who had undergone appendicectomy were studied. Data was collected and analyzed critically.Results: Males 66 (60%) outnumbered females 44 (40%) and overall mean age was 26.61±12.37 years. Of the 110 patients, 9% were normal appendix, 59.09% were confirmed as acute appendicitis while 31.81% were diagnosed with complicated appendicitis on biopsy. The Sensitivity and Specificity of serum bilirubin as a marker in predicting Acute appendicitis and complicated appendicitis was 47.6% and 90.9% respectively. Similarly, the Positive predicative value and Negative predicative value for the same was 88.5% and 61.5% respectively with odds ratio 12.4 with significant p value <0.0001.Conclusions: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia should be identified as having a higher probability of complicated appendicitis. Hence, serum bilirubin levels have a predictive potential for the diagnosis of severity of acute appendicitis and need for early appendicectomy. If total serum bilirubin is added to already existing laboratory tests, then the diagnosis of complicated appendicitis in clinically suspected cases can be made with fair degree of accuracy, the need for CECT and MRI can be reduced and unnecessary delay in appendicectomy can be avoided.

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Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

10.21203/rs.2.21496/v6 ◽

2021 ◽

Author(s):

Sabyasachi Bakshi ◽

Nilay Mandal

Keyword(s):

Acute Appendicitis ◽

Likelihood Ratio ◽

Bilirubin Level ◽

Predictive Value ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Total Bilirubin Level ◽

Complicated Appendicitis ◽

Total Serum

Abstract BACKGROUND:In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied.METHODS:After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination.RESULTS:Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was Mixed Type Of Hyperbilirubinemia in gangrenous/perforated appendicitis.The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively.Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of Complicated appendicitis be 31.80%.ROC (Receiver Operating Characteristic) curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence.CONCLUSIONS:This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications.Trial Registration: Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019.This was a prospective trial. Trial URL:http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27

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Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

10.21203/rs.2.21496/v5 ◽

2020 ◽

Author(s):

Sabyasachi Bakshi ◽

Nilay Mandal

Keyword(s):

Acute Appendicitis ◽

Likelihood Ratio ◽

Bilirubin Level ◽

Predictive Value ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Total Bilirubin Level ◽

Complicated Appendicitis ◽

Total Serum

Abstract BACKGROUND:In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied.METHODS:After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination.RESULTS:Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was Mixed Type Of Hyperbilirubinemia in gangrenous/perforated appendicitis.The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively.Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of Complicated appendicitis be 31.80%.ROC (Receiver Operating Characteristic) curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence.CONCLUSIONS:This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications.Trial Registration: Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27

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Study of the association of serum procalcitonin with leukocytosis in predicting complicated acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20202839 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2300

Author(s):

Thana Ram Patel ◽

Amit Jain ◽

Lakshman Agarwal ◽

Vakta Ram Choudhary ◽

Dinesh Bijarniya

Keyword(s):

Acute Appendicitis ◽

Sensitivity And Specificity ◽

Complicated Appendicitis ◽

Protein Levels ◽

Reactive Protein ◽

Level Measurement ◽

Wbc Count ◽

Operative Findings ◽

Age Range ◽

Complicated Acute Appendicitis

Background: Delay in the diagnosis of complicated appendicitis and its treatment results in an increased rate of postoperative morbidity, mortality and hospital stay. The diagnosis of appendicitis rests on a combination of signs of inflammation such as fever, pain and tenderness; leukocytosis, and elevated C-reactive protein levels, interleukin-6 (IL6) and procalcitonin. Raised level of serum procalcitonin in bacterial infection has been used to further improve the diagnosis of complicated AA.Methods: One-hundred ten patients of appendicitis confirmed by intra-operative findings and final pathologist report, who underwent appendectomy consisting 25 women (22.73%) and 85 men (77.27%) with a mean age of 25 years (age range 15-55 years) were included in this study. Serum procalcitonin value was measured by chemi E411 Cobas method (chemilumiscent immunoassay system) using the B.R.A.H.M.S PCT kit. Serum PCT level >0.5 ng/ml was consider as risk for progression to severe systemic disease.Results: At a 0.5 ng/dl cut-off value of PCT, the sensitivity and specificity of PCT level measurement for acute complicated appendicitis prediction was 90% and 97.14% respectively. Association between WBC count and PCT value shows the sensitivity and specificity in 40 case of acute complicated appendicitis prediction was 86% and 75% respectively.Conclusions: Both the higher PCT values and leukocytosis correlates well with infectious post-operative complications for acute appendicitis and it can help to carry out timely surgical intervention which is highly recommended in complicated appendicitis(correlates PCT >0.5 ng/dl).

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Evaluation of Role of Hyperbilirubinemia as a New Diagnostic Marker of Complicated Appendicitis.

10.21203/rs.2.21496/v3 ◽

2020 ◽

Author(s):

Sabyasachi Bakshi ◽

Nilay Mandal

Keyword(s):

Acute Appendicitis ◽

Likelihood Ratio ◽

Bilirubin Level ◽

Predictive Value ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Total Bilirubin Level ◽

Complicated Appendicitis ◽

Total Serum

Abstract BACKGROUND:In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi.In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied.METHODS:After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination.RESULTS:Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03(8.58%) had normal levels .Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels .It was Mixed Type Of Hyperbilirubinemia in gangrenous/perforated appendicitis.The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively.Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of Complicated appendicitis be 31.80%.ROC (Receiver Operating Characteristic) curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence.CONCLUSIONS:This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial Registration: Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27

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Discriminating complicated from uncomplicated appendicitis by ultrasound imaging, computed tomography or magnetic resonance imaging: systematic review and meta-analysis of diagnostic accuracy

BJS Open ◽

10.1093/bjsopen/zraa030 ◽

2020 ◽

Vol 5 (2) ◽

Author(s):

W J Bom ◽

M D Bolmers ◽

S L Gans ◽

C C van Rossem ◽

A A W van Geloven ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Ultrasound Imaging ◽

Predictive Value ◽

Complicated Appendicitis ◽

Cochrane Library ◽

Uncomplicated Appendicitis ◽

Mean Sensitivity ◽

Ct And Mri

Abstract Background Discriminating complicated from uncomplicated appendicitis is crucial. Patients with suspected complicated appendicitis are best treated by emergency surgery, whereas those with uncomplicated appendicitis may be treated with antibiotics alone. This study aimed to obtain summary estimates of the accuracy of ultrasound imaging, CT and MRI in discriminating complicated from uncomplicated appendicitis Methods A systematic literature review was conducted by an electronic search in PubMed, Embase and the Cochrane Library for studies describing the diagnostic accuracy of complicated versus uncomplicated appendicitis. Studies were included if the population comprised adults, and surgery or pathology was used as a reference standard. Risk of bias and applicability were assessed with QUADAS-2. Bivariable logitnormal random-effect models were used to estimate mean sensitivity and specificity. Results Two studies reporting on ultrasound imaging, 11 studies on CT, one on MRI, and one on ultrasonography with conditional CT were included. Summary estimates for sensitivity and specificity in detecting complicated appendicitis could be calculated only for CT, because of lack of data for the other imaging modalities. For CT, mean sensitivity was 78 (95 per cent c.i. 64 to 88) per cent, and mean specificity was 91 (85 to 99) per cent. At a median prevalence of 25 per cent, the positive predictive value of CT for complicated appendicitis would be 74 per cent and its negative predictive value 93 per cent. Conclusion Ultrasound imaging, CT and MRI have limitations in discriminating between complicated and uncomplicated appendicitis. Although CT has far from perfect sensitivity, its negative predictive value for complicated appendicitis is high.

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Comparison of Sensitivity of TLC and Liver Assay in Diagnosing Appendicitis and Complicated Appendicitis at a Rural Medical Institution

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/557 ◽

2020 ◽

Vol 7 (46) ◽

pp. 2710-2713

Author(s):

Sandeep Kumar Goyal ◽

Vilkram Saini ◽

Minaxi Saini ◽

Gopal Singhal ◽

Kanishak Mehta ◽

...

Keyword(s):

Liver Function ◽

Acute Appendicitis ◽

Serum Bilirubin ◽

Clinical Signs ◽

Liver Function Tests ◽

Complicated Appendicitis ◽

Total Serum Bilirubin ◽

Total Leukocyte Count ◽

Total Serum ◽

Function Tests

BACKGROUND Diagnosis of acute appendicitis is always a challenging task in emergency ward which can most of the time be diagnosed with thorough history and physical examination by surgeon, various clinical signs and laboratory investigations like total leukocyte count (TLC), neutrophils shift to left. Unnecessary surgical interventions of appendix can be reduced by precise diagnosis of levels of TLC and total serum bilirubin values. We wanted to evaluate the sensitivity of laboratory marker like TLC and liver function tests in diagnosing a case of appendicitis and complicated appendicitis. METHODS 100 patients who were admitted in the Department of General Surgery, Maharaja Agrasen Medical Collage, Agroha (Hisar), with clinical diagnosis of acute appendicitis were included in the study. Data was statistically analysed and sensitivity of TLC and liver function test in diagnosing acute appendicitis was compared. RESULTS Sensitivity of TLC was found to be 47 %; that of total serum bilirubin was 72 % which is significant; that of SGOT was 26 %; that of SGPT was 21 % and that of ALP was 8 % in diagnosing acute appendicitis. While comparing sensitivity of this marker to diagnose complicated appendicitis (gangrenous and perforated appendix) it was 56.3 % for TLC, 100 % for total serum bilirubin, 31.3 % for SGOT, 37.5 % for SGPT and 12.5 % for ALP. CONCLUSIONS Raised total serum bilirubin has potential to detect complications of appendicitis and the need for early intervention by surgeon. KEYWORDS Appendicitis; Liver Function Tests; Serum Bilirubin

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TP10.2.10A Prospective Analysis of Imaging Modalities in Appendicitis during the COVID-19 Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab362.147 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Nivetha Saravanan ◽

Hannah Javanmard-Emamghissi ◽

Jonathan Lund ◽

Gillian Tierney

Keyword(s):

Primary Outcome ◽

Complicated Appendicitis ◽

Prospective Analysis ◽

Histological Findings ◽

Suspected Appendicitis ◽

Secondary Outcomes ◽

Operative Findings ◽

The Uk ◽

Appendiceal Perforation ◽

Made In

Abstract Aims Acute appendicitis is a common general surgical emergency, occurring in 90-100 per 100,000 patients per year. Clinical practice in the UK involves either a clinical or ultrasound (US) diagnosis, with computed tomography (CT) reserved for cases of suspected complicated appendicitis. Due to the COVID-19 pandemic management pathways were altered, this study sought to capture that. Methods This prospective study included adult patients with suspected appendicitis at a single UK centre from March-June 2020. The primary outcome measures were rates of US and CT imaging. Secondary outcomes included subsequent operative and histological findings. Results Seventy-five patients were included. A clinical diagnosis of appendicitis was made in 11 (15%). Thirty-five (47%) patients had CT, 22 (29%) had an US and 7 (9%) had both. The appendix was visualised in only 10 patients and a radiological diagnosis of appendicitis was made in 6 cases. Appendicitis was confirmed on histology in 67% of subsequently operated cases. CT evidence of appendicitis correlated with operative appendicitis in 93% (28/30) of cases. There were two cases of appendiceal malignancy not demonstrated on CT. Correlation of complicated appendicitis between CT and operative findings was poor; one third (10/28) of patients had appendiceal perforation not identified on CT. Conclusions The use of CT for diagnosing appendicitis was markedly increased during the first wave of the pandemic. The appendix was visualised infrequently on ultrasound, but when seen correlated well with histological findings. CT was superior at detecting appendicitis but failed to differentiate well between complicated and uncomplicated disease.

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Predictive ability of CT findings in the differentiation of complicated and uncomplicated appendicitis: a retrospective investigation of 201 patients undergone appendectomy at initial admission

Insights into Imaging ◽

10.1186/s13244-021-01086-3 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Jidapa Iamwat ◽

Wanwarang Teerasamit ◽

Piyaporn Apisarnthanarak ◽

Napakadol Noppakunsomboon ◽

Rathachai Kaewlai

Keyword(s):

Fluid Collection ◽

Predictive Ability ◽

Standard Of Care ◽

Complicated Appendicitis ◽

Clinical Predictors ◽

Ct Findings ◽

Uncomplicated Appendicitis ◽

Preoperative Ct ◽

Operative Findings ◽

Sensitivity Specificity

Abstract Background Paradigm shift toward nonoperative management (NOM) of adult appendicitis has made computed tomography (CT) more important than ever, particularly in differentiating complicated from uncomplicated disease. Complete surgical and pathological data of appendicitis in a place where appendectomy at initial admission is a standard of care would allow retrospective review of preoperative CT for performance and predictive ability in identifying those that may benefit from NOM in the future. Results The study included 201 CT scans of consecutive adult patients who presented for appendectomy at initial admission with pathologically confirmed acute appendicitis. Complicated appendicitis referred to gangrene or perforation on pathological or operative findings. The overall CT sensitivity, specificity and accuracy for differentiation of complicated from uncomplicated appendicitis were 87.2%, 75.7% and 81.1%, respectively. The most sensitive CT findings of complicated appendicitis were mucosal enhancement defect (83.2%; 95% CI 74.1–90.0) and moderate-to-severe periappendiceal fat stranding (96.8%; 95% CI 91.1–99.3), both independently predictive of complicated appendicitis with adjusted odds ratios (ORs) of 4.62 (95% CI 1.86–11.51) and 4.41 (95% CI 1.06–18.29), respectively. Phlegmon, fluid collection, extraluminal appendicolith, periappendiceal air and small bowel dilatation had specificity of 98.1–100%. Intraluminal appendicoliths were found more frequently in complicated appendicitis (52.6% vs. 22.6%) but not predictive for this diagnosis. Independent clinical predictors of complicated appendicitis were lack of pain migration (OR 2.06), neutrophilia ≥ 82% (OR (2.87) and symptoms ≥ 24 h (OR 5.84). Conclusions CT findings were highly accurate in differentiating complicated from uncomplicated appendicitis among patients undergone appendectomy at initial admission.

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