NEGATIVE APPENDECTOMY

Acute appendicitis is the most common surgical emergency. Despite advancesin diagnostic techniques, an accurate pre-operative diagnosis may still pose a challenge tothe clinicians. Therefore, even today we are facing a high rate of negative appendectomy.The current study explores this aspect of a common and important disease. Objectives: Toknow the percentage of negative operative findings in acute appendicitis in our hospital thatdrains wide area of population from lower socioeconomic strata. Patients and methods: Thisprospective cross-sectional study was conducted at Department of Surgery, Lady ReadingHospital, Peshawar within two years from 1-1-2009 to 31-12-2010. This study included 673cases undergoing appendectomy. All the patients operated for clinical diagnosis of acuteappendicitis over the study period were included. Their history, clinical features, and resultsof investigations were noted. Gross examination of intact appendix specimen, and on-tablecross sectional inspection of appendix was made; and were correlated with histopathologicalfindings (as gold standard). Results: The study included 673 patients. There were 478 males(70%), and highest number of patients was in second decade of life. On gross examination,545 (81%) appendices were swollen, 531 (79%) were reddened due to inflammation; 63 (9.4%)were gangrenous; and 50 (7.5%) had perforated; while in 128 patients (19%) the appendix wasnormal looking with shiny surface. Fibrino-purulent exudate in the peri-appendeceal regionwas noticed in 253 (37.6%) patients. The cut section of appendix showed wall abscess in 474(70.4%) cases, and mucosal ulceration in 325 (48.2%). Necrotic foci in mucosa were seen in188 (27.6%) cases, and in 61 cases (9%) the necrosis was extending through the wall up toserosa. Histopathology revealed marked acute inflammation in 416 (61.8%) cases, moderateinflammation in 92 (13.7%), and mild inflammation in 47 (6.9%); while in 118 cases the appendixhad no evidence of inflammation (giving negative appendectomy rate of 17.5%). Negativeappendectomy rate in females was 29.2% compared to 12.7% in males. Probable alternatediagnoses are also addressed. Conclusions: The negative appendectomy can be avoidedin many cases if ultrasound facilities were available during odd hours of patient presentation.Similarly, the rate of negative appendectomy can be further reduced in adults, especially femalesaround puberty and reproductive age, by the provision of laparoscopy during emergency hoursof the day.

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A review of appendectomy cases at a single teaching hospital, Baghdad, Iraq

International Surgery Journal ◽

10.18203/2349-2902.isj20173379 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2434

Author(s):

Mohanad Hamed Abdullah ◽

Mahmood J. Saood ◽

Naser R. Tawfiq

Keyword(s):

Acute Appendicitis ◽

Length Of Hospital Stay ◽

Cross Sectional Study ◽

Reproductive Age ◽

Preoperative Imaging ◽

Negative Appendectomy ◽

Cross Sectional ◽

Patient Demographics ◽

Incidental Appendectomy ◽

Negative Appendectomy Rate

Background: Appendectomy is one of the most commonly performed operations. Accurate preoperative diagnosis has long been a great challenge, even to experienced surgeons. To determine the pattern of presentation and rate of atypical pathological presentation of appendicitis.Methods: This is a cross-sectional study in which patients who underwent appendectomy for presumed acute appendicitis from June 2012 to June 2016 were recruited. Incidental appendectomy was excluded. Patient demographics, pathological findings, and surgical outcomes were collected.Results: It was found that the median age of the patients with acute appendicitis was 29 (male 27.3, female 30.7; range (4-67) years. The median length of hospital stay was 2 (range, 1-22) days. There were 184 (75%) patients with clinically and pathologically confirmed acute appendicitis. Out of the 243 patients, 47 appendices were normal, making the overall negative appendectomy rate (NAR) 19.3%; 14.0% in males and 24.6% in females (P<0.001).Conclusions: Appendectomy continues to be a very common surgical procedure. We suggest a more liberal utilisation of preoperative imaging in females of reproductive age, and patients at the extreme age.

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NEGATIVE APPENDECTOMIES ARE MORE COMMON IN FEMALES OF REPRODUCTIVE AGE GROUP

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v6i6.4630 ◽

2021 ◽

Vol 71 (6) ◽

pp. 2011-14

Author(s):

Zahid Ali ◽

Muhammad Rahil Khan ◽

Riyasat Ahmed Memon ◽

Ikram Din Ujjan ◽

Fida Hussain ◽

...

Keyword(s):

Acute Appendicitis ◽

Histopathological Examination ◽

Age Groups ◽

Scoring Systems ◽

Cross Sectional Study ◽

Reproductive Age ◽

Negative Appendectomy ◽

Age Group ◽

Cross Sectional ◽

Reproductive Age Group

Objective: To compare the negative appendectomy in the females of reproductive and non-reproductive age groups. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pathology, Diagnostic and Research Laboratory, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan, from January 2018 to December 2019. Methodology: A total of 1126 appendectomy specimens were enrolled irrespective of age and gender. The biodata of patients was retrieved from the database. Statistical analysis was done using SPSS version 22. Results: Out of total 1126 reported cases, 787 (69.9%) were males and 339 (30.1%) were females. The mean age was calculated to be 24.43 ± 12.42 years ranging from 2-94 years. Histopathological examination revealed cases of acute appendicitis 374 (33.2%), acute appendicitis with peri-appendicitis 478 (42.5%), fibrous obliteration 28 (2.5%) and parasitic infestation 7 (0.6%). Overall negative appendectomies were 219 (19.4%) and were prominent in females 100 (29.5%) than males 119 (15.1%). Also it was higher in females of reproductive age group 77 (30.4%) than in non-reproductive age group 23 (27.9%). Conclusion: In our study negative appendectomy in females of reproductive age groups was found to be higher than expected. Clinical scoring systems, biochemical markers, imaging modalities, and second opinion from other specialties like internal medicine, gynae and obstetric have been introduced to substantiate the diagnosis of acute appendicitis and thereby decreases the negative appendectomy.

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Advantage of ultrasonography in the diagnosis of acute appendicitis at Al-Karama Teaching Hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20190467 ◽

2019 ◽

Vol 6 (3) ◽

pp. 702

Author(s):

Mohammed Hillu Surriah ◽

Amine Mohammed Bakkour ◽

Nidaa Ali Abdul Hussain

Keyword(s):

Acute Appendicitis ◽

Teaching Hospital ◽

Predictive Value ◽

Diagnostic Technique ◽

Cost Effective ◽

Cross Sectional Study ◽

Negative Appendectomy ◽

Cross Sectional ◽

Suspected Appendicitis ◽

Presenting Symptoms

Background: The clinical diagnosis of acute appendicitis remains a challenge to surgeons. Different aids were introduced to improve the diagnostic accuracy. Among these modalities, ultrasonography is simple, easily available, non-invasive, convenient and cost effective. The aim of the study was to determine the validity of ultrasound in diagnosis of the acute appendicitis in those with clinically diagnosed patients.Methods: A cross sectional study was carried out in Al-Karama teaching hospital for thirty months from the period of 1st June 2016 to 1st December 2018. All patients with suspected appendicitis underwent clinical evaluation then sent for US. Results of surgeries, where relevant, were compared against US results. Positive and negative appendices on histopathology were regarded in accordance to the criteria which was negative appendectomy was defined as normal looking appendix and absence of acute inflammation on histopathology while positive cases included appendices showing acute inflammatory changes. Sensitivity, specificity and overall accuracy was calculated.Results: A total of 435 patients with suspected appendicitis, males 224 (51.49%) and females 211 (48.50%) were included in present study. There were no significant differences between patients with positive and negative histopathology findings regarding presenting symptoms. There was a significant association between (cough sign, localized tenderness sign and pointing sign) and patients with positive histopathology findings. Regarding to the validity results of ultrasound in comparison to histopathology findings were accuracy 87.6%, sensitivity 87.8%, specificity 85.3%, positive predictive value 98.6% and negative predictive value 62.8%.Conclusions: The ultrasonography had a good accuracy, sensitivity and specificity in diagnosing acute appendicitis cases. Negative with ultrasonography results should be re-examined with different diagnostic technique like CT-scan.

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Clinical symptoms, paraclinical tests and histopathological results in children with acute appendicitis in Zabol southeast of Iran: a cross-sectional study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172596 ◽

2017 ◽

Vol 5 (7) ◽

pp. 2836

Author(s):

Mehran Hesaraki

Keyword(s):

Acute Appendicitis ◽

Clinical Signs ◽

Signs And Symptoms ◽

Cross Sectional Study ◽

Intestinal Loop ◽

Negative Appendectomy ◽

Sectional Study ◽

Cross Sectional ◽

Clinical Signs And Symptoms ◽

Histopathological Results

Background: This article aimed to assessment clinical signs and symptoms, paraclinical tests and histopathological results in children with acute appendicitis.Methods: A cross-sectional study conducted on 100 children with acute appendicitis in an urban hospital in southeast of Iran from January to December 2016. Participants were selected by simple random sampling method. Clinical signs and symptoms, paraclinical tests and histopathological results recorded in checklists. The data were analyzed using SPSS 22.Results: Mean age of the patients was 10.26±3.25, fourthly-eight of patients (58.5%) were males and 34 patients (41.5%) were females. The most frequent clinical signs and symptoms were acute suppurative appendicitis with peri appendicitis (45.83%) and acute suppurative appendicitis (39.58%). The most frequent results in ultrasound reports were Intestinal loop thickness greater than 6 mm without peristalsis (positive report) (46.34%) and Invisible appendix (nega Hesaraki tive report) (13.41%).Conclusions: The results of this study showed that abdominal pain and RLQ tenderness were the most common signs and symptoms and WBC left-shift was the most common laboratory finding. Since the rate of negative appendectomy in this study was consistent with surgical results and other articles, it is concluded that diagnostic accuracy of preoperative appendectomy was acceptable and most children with acute appendicitis underwent appendectomy.

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Tibial Spine Fractures: How Much Are We Missing Without Pretreatment Advanced Imaging? A Multicenter Study

The American Journal of Sports Medicine ◽

10.1177/0363546520957666 ◽

2020 ◽

Vol 48 (13) ◽

pp. 3208-3213

Author(s):

Jilan L. Shimberg ◽

Julien T. Aoyama ◽

Tomasina M. Leska ◽

Theodore J. Ganley ◽

Peter D. Fabricant ◽

...

Keyword(s):

Patient Characteristics ◽

Cross Sectional Study ◽

High Rate ◽

Spine Fractures ◽

Level Of Evidence ◽

Concomitant Injuries ◽

Cross Sectional ◽

Tibial Spine ◽

Concomitant Injury ◽

Operative Findings

Background: There is a high rate of concomitant injuries reported in pediatric patients with tibial spine fractures, ranging from 40% to 68.8%. Many tibial spine fractures are treated without initial magnetic resonance imaging (MRI). Purpose: To understand rates of concomitant injury and if the reported rates of these injuries differed among patients with and without pretreatment MRI. Study Design: Cross-sectional study; level of evidence, 3. Methods: We performed an institutional review board–approved multicenter retrospective cohort study of patients treated for tibial spine fractures between January 1, 2000, and January 31, 2019, at 10 institutions. Patients younger than 25 years of age with tibial spine fractures were included. Data were collected on patient characteristics, injury, orthopaedic history, pretreatment physical examination and imaging, and operative findings. We excluded patients with multiple trauma and individuals with additional lower extremity fractures. Patients were categorized into 2 groups: those with and those without pretreatment MRI. The incidence of reported concomitant injuries was then compared between groups. Results: There were 395 patients with a tibial spine fracture who met inclusion criteria, 139 (35%) of whom were reported to have a clinically significant concomitant injury. Characteristics and fracture patterns were similar between groups. Of patients with pretreatment MRI, 79 of 176 (45%) had an identified concomitant injury, whereas only 60 of 219 patients (27%) without pretreatment MRI had a reported concomitant injury ( P < .001). There was a higher rate of lateral meniscal tears ( P < .001) in patients with pretreatment MRI than in those without. However, there was a higher rate of soft tissue entrapment at the fracture bed ( P = .030) in patients without pretreatment MRI. Overall, 121 patients (87%) with a concomitant injury required at least 1 treatment. Conclusion: Patients with pretreatment MRI had a statistically significantly higher rate of concomitant injury identified. Pretreatment MRI should be considered in the evaluation of tibial spine fractures to improve the identification of concomitant injuries, especially in patients who may otherwise be treated nonoperatively or with closed reduction. Further studies are necessary to refine the indications for MRI in patients with tibial spine fractures, determine the characteristics of patients at highest risk of having a concomitant injury, define the sensitivity and specificity of MRI in tibial spine fractures, and investigate patient outcomes based on pretreatment MRI status.

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Frequency and outcome of complicated appendicitis in toddlers and pre-schoolers

Journal of Pediatric and Adolescent Surgery ◽

10.46831/jpas.v1i1.5 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Naseem Khan ◽

Muhammad Ayub Khan ◽

Jehangir Khan ◽

Sajjad Ali ◽

Imran Khattak ◽

...

Keyword(s):

Acute Appendicitis ◽

Pediatric Population ◽

Perforated Appendicitis ◽

Cross Sectional Study ◽

Complicated Appendicitis ◽

Cross Sectional ◽

Generalized Peritonitis ◽

Operative Findings ◽

Study Participants ◽

Emergency Abdominal Surgery

Background: Acute appendicitis is a frequent indication of emergency abdominal surgery in the pediatric population. In younger children, especially toddlers, and preschoolers, the presentation is comparatively late resulting in complicated appendicitis. This study was done to determine the frequency and outcome of complicated appendicitis in toddlers and preschoolers. Methods: This is a cross-sectional study done at the Department of Pediatric Surgery, Lady Reading Hospital Peshawar, during August 2018 and February 2019. The medical records of 144 toddlers and preschoolers who presented with acute appendicitis were reviewed for demography, clinical presentation, operative findings, and outcome. Frequency and types of complicated appendicitis were recorded. Results: The mean age of study participants was 3 years (±2.84), including 46(32%) toddlers and 98(68%) preschoolers. Overall 62% of patients were male while 38% of patients were female. Complicated appendicitis was documented in 75% of patients. The common types of complicated appendicitis were perforation of the appendix with a localized abscess in 68 patients, gangrenous appendicitis in 4 patients, generalized peritonitis in 24 patients, and mass formation in 12 patients. All patients did well after surgery, except one who succumbed to complications of leukemia. Conclusion: In our study, a great deal (75%) of toddlers and preschoolers had complicated appendicitis especially perforated appendicitis with localized peritonitis.

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ATONIC UTERUS;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.06.2732 ◽

2014 ◽

Vol 21 (06) ◽

pp. 1122-1127

Author(s):

Bilqees Ara ◽

Zaib-un- Nisa ◽

Firdos Ara ◽

Palwasha Kakar ◽

Abdul Salam ◽

...

Keyword(s):

Mode Of Delivery ◽

Previous History ◽

Sampling Technique ◽

Cross Sectional Study ◽

Uterine Atony ◽

Reproductive Age ◽

Sectional Study ◽

Inform Consent ◽

Cross Sectional ◽

Number Of Patients

Objective: This study was designed to determine the frequency of uterine atony in cases of primary postpartum hemorrhage (PPH) and to point out risk factors for it and observe different ways of management for control of atonic primary (PPH). Design: Prospective cross sectional study. Place and Duration of Study: This prospective cross sectional study was conducted in Obstetrics & Gynecology Department unit-I, Bolan Medical Complex Hospital Quetta from 1st January to 31st December 2002 (one year). The study was conducted on 80 patients. Subjects and Methods: The study included all the pregnant women either booked or non-booked, who gave the inform consent. The sampling technique was convenience non probability. The patients were admitted through out-patient department and emergency, irrespective of age, place and mode of delivery, developing atonic primary PPH within twenty four hours and diagnosed as a case of uterine atony. All the cases of primary PPH other than due to uterine atony were excluded. Complete history, general physical examination, abdominal examination and pelvic examination was done.All the data was analyzed by SPSS version 10. Results: Total number of deliveries during study period was 1438. Total number of patients with PPH were 155 out of which, the cases with primary PPH were 139, contributing about 89.7%. The incidence of primary PPH was 9.6 %. Out of 139 patients, the leading cause of primary PPH was uterine atony, contributing to 57.6%. The incidence of atonic uterus was 5.6 %. The highest incidence of uterine atony (37.5%) was found in women aged 26-30 years, followed by (27.5%) women aged 21-25 years.The highest incidence of primary PPH due to uterine atony was found in para 5-8 (56.3%), 6.3 % were primigravidas, 8.7% in para 1-4 and 28.7% in patients having more than eight children. Simple management included inj. Syntometrine, Oxytocin, uterine massage controlled bleeding in 53.7% cases. Prostaglandins (PGF2-alpha & PGE2) were administered in 32 cases & successful in 22 (68.7%) cases. Uterine packing was done in 8 cases, out of it, in 5 patients bleeding controlled (62.5%). Ligation of uterine arteries was performed in 5 cases, it proved successful in 4(80%) & hysterectomy was done in 7.5% cases. Conclusions: Uterine atony is a major cause of primary PPH and major threat to the life of women in reproductive age. Uterine atony is more common in grand multipara, young women and in home delivery. Major risk factor for atony are previous history of primary PPH, grand multiparity, baby weight > 3.5kg & prolonged labour.

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ROLE OF ULTRASONOGRAPHY FOR EVALUATION OF ACUTE APPENDICITIS: A UNAMID EXPERIENCE

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-1.6214 ◽

2021 ◽

Vol 71 (Suppl-1) ◽

pp. S255-60

Author(s):

Muhammad Tahsin Hashmi ◽

Irum Taqi ◽

Amberin Taqi ◽

Hassan Junaid Sarwar

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Predictive Value ◽

Cross Sectional Study ◽

Point Scale ◽

Field Hospital ◽

Cross Sectional ◽

Lower Quadrant ◽

Persistent Symptoms ◽

Operative Findings

Objective: To evaluate the accuracy of ultrasound findings as compared to operative findings and positive predictive value of ultrasonography in the diagnosis of acute appendicitis. Study Design: Cross sectional study. Place and Duration of Study: Pak Field Hospital – 7 (Level III) United Nations African Union Mission in Darfur (UNAMID) Darfur, Sudan, from Mar 2015 to Mar 2016. Methodology: All patients presenting with clinically suspected acute appendicitis (Alvarado’s score >4) were referred for right lower quadrant sonography. Three point scale was used to grade sonographic findings ranging from grade 1 to grade 3. Fifty One patients with persistent symptoms and/or positive sonographic findings were operated. Operative findings were also graded on a 3 point scale. Subsequently, sonographic and operative findings were compared. Surgical findings were considered gold standard to assess diagnostic accuracy of sonography. Results: Out of 51 patients 46 (90.2%) were males and 5 (9.8%) were females. Mean age of the patients was 32.3 ± 7.3 years. Among the study subjects, 15 (29.4%) patients were from Nigeria followed by 12 (23.5%) from Pakistan, 7 (13.7%) from Egypt and 17 (33.5%) from other countries.The sonographic findings were detected positive for acute appendicitis in 40 (78.4%) and negative in 11 (21.6%) out of 51. All Fifty-one patients underwent surgery. The surgical findings were positive for appendicitis in 43 patients (84.3%). Four patients with negative sonographic findings did have acute appendicitis according to surgical findings. The positive predictive value was 90.9%. There was good agreement between sonographicfindings and surgical findings..........

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Morbidity and Mortality Pattern of Appendicitis in Rural Teaching Hospital of Nepal

Journal of Karnali Academy of Health Sciences ◽

10.3126/jkahs.v3i2.30840 ◽

2020 ◽

Vol 3 (2) ◽

pp. 88-94

Author(s):

Suryaman Menyangbo ◽

Gakul Bhatta ◽

Kripa Subedi ◽

Bibek Pun Magar ◽

Harihar Devkota ◽

...

Keyword(s):

Acute Appendicitis ◽

Local Level ◽

Cross Sectional Study ◽

Morbidity And Mortality ◽

Western World ◽

Mortality Pattern ◽

Cross Sectional ◽

Suspected Appendicitis ◽

Considerable Morbidity ◽

Operative Findings

Background: Acute appendicitis is the most common cause of surgical acute abdomen. It contributes for 40 % of all emergency performed abdominal surgeries in western world and 26 % it accounts for in Nepal. The treatment of acute appendicitis remains a health problem and considerable morbidity and mortality are still associated with it. Perforation, abscess formation, appendicular lump and surgical site of infection are well reported morbidities. Late arrival in hospital and use of inadequate dose of antibiotics in local might have association in increasing morbidities. The aim of the study is to observe the morbidity and mortality in appendicitis patients belonging to this Midwestern region of Nepal. Methods: This retrospective cross sectional study was carried out in the Karnali academy of health sciences, Jumla Nepal. The data includes the 5 years period from Jan 2014 to March 2020. The parameters included admission of acute appendicitis, age, gender, post-operative findings and complication. Results: There were 186 cases collectively. 175 cases of appendicitis were recorded. The mean age was 31±15.16. Ninety two (52.6%) were female; 83(47.4%) were male. 119(68%) had appendectomies. 56(32%) were treated conservatively. 29(51.78%) were appendicular lump and 27(48.2%) were suspected appendicitis. Five were found to have perforation of appendix. Two had abscess in 29 cases of appendicular mass. 2 had surgical site infection. Conclusion: Among patients who were admitted in the hospital with diagnosis of acute appendicitis, the commonest complication is the appendicular lump, which might be due to late hospital arrival or early antibiotics use impulsively at local level, followed by perforation appendix. The result supports both appendectomy and conservative treatment are equally feasible for acute appendicitis accordingly the cases presented in the hospital.

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Diagnostic Accuracy Of RIPASA Scoring System In Presumptive Accurate Diagnosis Of Acute Appendicitis : A case control study

10.22541/au.162740073.30858831/v1 ◽

2021 ◽

Author(s):

Mehwish Mooghal ◽

Wajiha Khan ◽

Shahid Mehmood ◽

Lal Bux ◽

Asrar Ahmad ◽

...

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Scoring System ◽

Tertiary Care ◽

Cross Sectional Study ◽

Accurate Diagnosis ◽

Negative Appendectomy ◽

Care Hospital ◽

Cross Sectional ◽

Ripasa Score

Introduction: The RIPASA scoring system was established specifically for Asians. Chong CF in his study consisting of 312 patients who had an emergency appendectomy concluded that optimal cut-off threshold score for negative appendectomy was 7.5. Objective: To determine the diagnostic accuracy of RIPASA scoring system in presumptive accurate diagnosis of acute appendicitis by taking histopathology as the gold standard. Materials and methods: This Cross Sectional Study was carried out at Surgery department at a tertiary care hospital, Karachi over a period of 6 months, from 15th December 2019 to 15th June 2020. A total of 141 patients of both gender of suspected cases of acute appendicitis presenting with sign and symptoms were included in the study. Patients underwent detailed history, general and physical examination and scoring of patients according to RIPASA scoring scale and then decision of appendectomy was taken on the basis of RIPASA score. Removed appendix samples were sent for histopathology. Results: Age range in this study was from 15 to 50 years with mean age of 30.191±6.09 years and mean RIPASA score was 5.375±1.77. Majority of patients were males (58.9%). RIPASA score diagnosed 28(19.9%) and histopathology diagnosed 27(19.1%) patients with acute appendicitis. RIPASA score showed sensitivity of 85.2%, specificity 95.6%, diagnostic accuracy 94%, PPV 82.1% and NPV was 96.4%. Conclusion: We conclude that RIPASA scoring system is the scoring system of choice in diagnosis of the acute appendicitis with good sensitivity albeit a hit high and specificity albeit a bit low profile.

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