scholarly journals Role of Graded Compression Ultrasonography in Evaluation of Acute Appendicitis.

2015 ◽  
Vol 12 (2) ◽  
pp. 49-53
Author(s):  
Mukunda Singh Shrestha ◽  
Hom Prasad Pant ◽  
Shiv Bahadur Basnet ◽  
Govinda Bhahadur Khadka ◽  
Rajive Raj Shahi ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Iliac Fossa ◽  
Clinical Impression ◽  
High Morbidity ◽  
Emergency Setting ◽  
Compression Technique ◽  
Suspected Appendicitis ◽  
Right Iliac Fossa Pain ◽  
Compression Ultrasonography

Introduction: Acute appendicitis is common surgical emergency which can lead to high morbidity and mortalityin absence of timely treatment. Ultrasonography (USG) is commonly used to diagnose appendicitis and excludeother intraabdominal pathology leading to right iliac fossa pain in emergency setting. We aimed to Þ nd out thediagnostic value of graded compression USG in suspected appendicitis cases.Methods: Altogether 107 patients with clinical impression of acute appendicitis were followed. Four caseswere excluded because of other diagnosis established in USG. Appendicitis was diagnosed by standard criteriasof inß ammed appendix by graded compression technique. Informations of 103 cases were recorded in proformawhich was later entered in SPSS and statistical calculations done.Results: Out of 103 cases followed, 93 had appendicitis. Of those, 46 cases only showed inß ammed anddistended appendix, others showed ancillary features only. Males were more affected 61(65.6%) than females.Sensitivity, speciÞ city, positive predictive value, negative predictive value and accuracy of ultrasound indetecting appendicitis were 98.9%,90%,98.9%,90% and 97.1% respectively.Conclusions: Graded compression ultrasonography is good investigation modality in assessement of suspectedacute appendicitis.doi: http://dx.doi.org/10.3126/mjsbh.v12i2.12929

scholarly journals Evaluation of Ultrasonography in the Diagnosis of Acute Appendicitis with Histopathology as Gold Standard

2019 ◽  
Vol 14 (2) ◽  
pp. 13-16
Author(s):  
Ahmed N. Manea ◽  
Tawfeeq J. Mohammad ◽  
Sarmad J. Shehatha
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Gold Standard ◽  
Life Time ◽  
Categorical Variables ◽  
Histopathological Study ◽  
P Value ◽  
Compression Technique ◽  
Cross Sectional ◽  
Suspected Appendicitis

Background: Acute appendicitis is the most common surgical abdominal emergency with a life time prevalence of 1 to 7 individuals. Because the clinical diagnosis of acute appendicitis remains a challenge to surgeons, so different aids were introduced like different scoring systems, computer aided programs, ultrasonography, computerized tomography, Magnetic resonance imaging, Gastrointestinal tract contrast studies and laparoscopy to improve the diagnostic accuracy. Objective: To evaluate ultrasound in the diagnosis of acute appendicitis in those patients clinically diagnosed with histopathology as gold standard. Methods: A cross sectional study carried in Al-kindy Teaching Hospital through one year duration from 1st of may2015 to1st of May 2016. All included patients were subjected to ultrasonographic examination to assess the vermiform appendix with a graded compression technique. The Ultrasonography findings were recorded as positive and negative for acute appendicitis. All the appendices removed from the study patients were sent for histopathological study. Statistical analysis done using (SPSS) version 21, Chi-sequare test used for categorical variables and t-test was used to compare between two means. Level of significance (P value) set at ≤ 0.05. Results: A total of 215 patients with suspected appendicitis, males 112 (52.09%) and females 103(47.9%) were included in present study. The validity results of ultrasound in comparison with histopathology findings were as following; accuracy 86.5%, sensitivity 86.5%, specificity 86.6%, positive predictive value 99.8% and negative predictive value 32.5%. Conclusion: The ultrasonography has a good accuracy, sensitivity and specificity in diagnosing acute appendicitis.

scholarly journals DIAGNOSTIC EFFICACY OF MODIFIED ALVARADO SCORE OVER GRADDED COMPRESSION ULTRASONOGRAPHY

2013 ◽  
Vol 03 (03) ◽  
pp. 105-108
Author(s):  
Caren Dsouza ◽  
John Martis ◽  
Vinay Vaidyanathan
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Preoperative Diagnosis ◽  
Iliac Fossa ◽  
Diagnostic Efficacy ◽  
Alvarado Score ◽  
Predictive Values ◽  
Modified Alvarado Score ◽  
Sensitivity Specificity ◽  
Compression Ultrasonography

Abstract Background: Acute appendicitis is one of the commonest surgical emergencies. Despite a life time cumulative risk of nearly 7% its diagnosis remains a challenge. The risks of two primary outcomes must be balanced in the management of presumed appendicitis: perforation and misdiagnosis.The rate of misdiagnosis in certain populations is as high as 40%. Diagnostic aids like modified Alvarado score and ultrasonography can dramatically reduce the negative appendicectomies. Methods:Data was collected from 60 patients with complains of right iliac fossa pain over a period of 9 months to our hospital. All patients were categorised using the Alvarado score and Graded compression ultrasonography was done. The preoperative and histological findings were compared with the preoperative diagnosis. The collected data was analysed with regards to various parameters like sensitivity, specificity, predictive values and diagnostic accuracy. Results:In our study of 60 patients, 56 patients underwent appendicectomy out of which a histological confirmation of appendicitis was obtained for 50 patients, giving a negative appendicectomy rate of 12%.By taking a cut-off point of 7 for the Modified Alvarado score, a sensitivity of 97.56%, specificity of 66.67%, positive predictive value (PPV) of 95.23%, negative predictive value (NPV) of 80% and accuracy of 87.2% were calculated. Using the cut-off point of 6, a sensitivity of 90% specificity of 50%, PPV of 69.23%, NPV of 80% and accuracy of 55.56% were obtained. The sensitivity, specificity, PPV, NPV and accuracy rate of ultrasonography was 92.15%, 88.9%, 97.19%, 66.7% and 85%, respectively. Conclusion:The presence of a modified Alvarado score > 7 was found to be a dependable aid in the preoperative diagnosis of acute appendicitis. In cases where the score was negative or equivocal, ultrasonography greatly helped in the diagnosis thereby reducing the incidence of negative appendicectomies.

Does abdominal ultrasound is a useful tool in appendicitis diagnosis?

2018 ◽  
Vol 90 (3) ◽  
pp. 13-18 ◽  
Author(s):  
Mateusz Kamiński
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Iliac Fossa ◽  
Correct Diagnosis ◽  
Fluid Collection ◽  
Abdominal Ultrasound ◽  
Negative Appendectomy ◽  
Abdominal Sonography ◽  
Suspected Appendicitis ◽  
Sensitivity Specificity

Introduction: Acute appendicitis is the most common acute abdominal illness. Despite diagnosis progress there is still 20% negative appendectomy rate. The aim of the study was to determine the usefulness of abdominal sonography in diagnosis of acute appendicitis. Materials and methods: Data were collected retrospectively from 326 patients who were operated with suspected appendicitis and had abdominal ultrasound before surgery. Appendicitis was confirmed by pathologic reports. There were two variants of positive abdominal sonography. In the first variant, the positive ultrasound was visualized inflamed appendix. In the second variant, the sonographic diagnosis of appendicitis was based on visualized inflamed appendix or one of indirect signs of appendicitis – localized periappendiceal fluid collection, enlarged lymph nodes, thickening of intestinal wall in right iliac fossa. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were defined and compared. Results: 83,74% patients has appendicitis in pathologic report. In 39,53% cases appendix was visualized in abdominal ultrasound. In 65,95% cases of sonography indirect signs occurred. In the first variant sensitivity, specificity, PPV and NPV was 47,99%, 79,25%, 92,25% and 22,83%. In the second variant 67,77%, 43,40%, 86,05% and 20,72%. In the second variant sensitivity was significantly higher (p<0,001) but specificity was significantly lower (p<0,001). Conclusion: Limited sensitivity and specificity cannot confirm appendicitis. Typical clinical course with negative ultrasound should not delay the correct diagnosis and early surgical treatment.

scholarly journals Diagnostic role of Ultrasonography in acute appendicitis

2015 ◽  
Vol 10 (1) ◽  
pp. 45-49
Author(s):  
Md Khairul Islam ◽  
Md Selim ur Rahman ◽  
Syed Zoherul Alam ◽  
Arif Ahmed Khan ◽  
Md Tarikul Islam ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Predictive Value ◽  
Histopathological Examination ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Armed Forces ◽  
Compression Technique ◽  
Abdominal Ultrasonography

Introduction: Abdominal Ultrasonography (USG) is the most commonly used method for diagnosing acute appendicitis the most common surgical cause of acute abdomen. In this study, we observed the reliability of USG for diagnosing acute appendicitis. Objectives: To evaluate the role of ultrasonography in the diagnosis of acute appendicitis. Methods: In this study, we performed abdominal USG of 100 patients admitted with lower right abdominal pain and diagnosed as acute surgical abdomen according to the physical examination and laboratory findings. These patients were surgically treated by appendecectomy, and excised specimens were sent for histopathological examination. Results: One hundred patients were assessed in this study. Out of them 82.0% patients had acute appendicitis and diameter of their appendices were more or equal to 6 mm. Twenty nine percent of the patients were below 21 years of age. Intraluminal fluid was present in 81% of patients and peri-appendicular fluid was present in 66.7% of patients. Leucocytosis was present in 49% of the cases and neutrophilia in 84% of the cases. All of the patients presented with lower abdominal pain with migration of pain in 52% cases and they had right iliac fossa tenderness. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy rate of ultrasonography was 76.8%, 88.9%, 96.9%, 45.7% and 79.0%, respectively. 45 JAFMC Bangladesh. Vol 10, No 1 (June) 2014 Conclusion: Acute appendicitis is a common indication for emergency abdominal surgery. Proper clinical assessment is the mainstay of diagnosis in acute appendicitis and addition of routine abdominal ultrasound by graded compression technique can improve the diagnostic accuracy and adverse outcome. DOI: http://dx.doi.org/10.3329/jafmc.v10i1.22904 Journal of Armed Forces Medical College Bangladesh Vol.10(1) 2014

scholarly journals Comparison of clinical examination and ultrasonography in the diagnosis of acute appendicitis

2012 ◽  
Vol 7 (2) ◽  
pp. 34-40
Author(s):  
PK Chhetri ◽  
A Tayal ◽  
PK Deka
Keyword(s):  
Acute Appendicitis ◽  
Clinical Examination ◽  
Histopathological Examination ◽  
Imaging Modality ◽  
Iliac Fossa ◽  
Clinical Impression ◽  
Medical Sciences ◽  
Right Iliac Fossa Pain ◽  
Diagnostic Work ◽  
Work Up

This study was undertaken to compare clinical examination and ultrasonography (USG) in the diagnosis of acute appendicitis and to establish their accuracy in the diagnosis of acute appendicitis. 100 patients who presented to the emergency department with a clinical diagnosis of acute appendicitis were subjected to USG. After USG a specific diagnosis was made. Patients underwent appendicectomy on the basis of the surgeon‘s final clinical impression after correlating with USG findings. Histopathological examination of the appendicectomy specimen was taken as the gold standard for the diagnosis of acute appendicitis. Appendicectomy was performed in 74 patients. Out of these 74 cases, only 66 had appendicitis on histopathological examination. Eight normal appendixes were removed. Twenty-six patients were prevented from surgery after USG had shown an alternative diagnosis for the cause of pain in right iliac fossa. Clinical examination thus had a sensitivity and Positive Predictive Value (PPV) of 66%. USG examination made a preoperative diagnosis of acute appendicitis in 62 of the 66 patients. However the remaining 4 cases with appendicitis were missed by USG. USG had a sensitivity of 93.93%, specificity of 100%, PPV of 100%, NPV of 89.47% and an overall accuracy of 96% in the diagnosis of acute appendicitis. USG is thus a sensitive and specific imaging modality in the diagnostic work up of patients with right iliac fossa pain. USG may improve the diagnostic accuracy in patients with suspected acute appendicitis.Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-2, 34-40DOI: http://dx.doi.org/10.3126/jcmsn.v7i2.6678

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

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

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

scholarly journals Role of C-Reactive Protein, White Blood Cell Counts, Bilirubin Levels, and Imaging in the Diagnosis of Acute Appendicitis as a Cause of Right Iliac Fossa Pain

Cureus ◽  
2018 ◽  
Author(s):  
Shetty Sushruth ◽  
Chellappa Vijayakumar ◽  
Krishnamachari Srinivasan ◽  
Nagarajan Raj Kumar ◽  
Gopal Balasubramaniyan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Blood Cell ◽  
Iliac Fossa ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
Right Iliac Fossa Pain ◽  
White Blood Cell Counts

Can Computed Tomography Scan be Performed Effectively in the Diagnosis of Acute Appendicitis without the Added Morbidity of Rectal Contrast?

2008 ◽  
Vol 74 (10) ◽  
pp. 917-920 ◽  
Author(s):  
Daniel D. Dearing ◽  
Jamesa Recabaren ◽  
Magdi Alexander
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Ct Scanning ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Suspected Appendicitis ◽  
Ct Examination ◽  
Preoperative Ct ◽  
Negative Appendectomy Rate ◽  
Pathology Reports

The highest degrees of accuracy have been demonstrated for CT scans using rectal contrast in diagnosing appendicitis. However, the administration of rectal contrast is associated with patient discomfort and rarely, rectosigmoid perforation (0.04%). Additionally, the commonly accepted negative appendectomy rate is around 16 per cent. We performed a retrospective review of radiology, operative, and pathology reports of consecutive patients undergoing appendectomy or CT examination for appendicitis during 2006. CT scans were performed without rectal contrast. The accuracy of each type of inpatient CT examination and negative appendectomy rates were determined. Two hundred and thirty-eight patients underwent appendectomy. One hundred and thirty-four appendectomy patients (56%) received a preoperative CT scan. The negative appendectomy rates were 6.3 per cent overall, 8.7 per cent without CT examination and 4.5 per cent with CT (P = 0.3). Two hundred and forty-five inpatient CT scans were performed for suspected appendicitis with a sensitivity of 90 per cent, specificity of 98 per cent, accuracy of 94 per cent, positive predictive value of 98 per cent, and negative predictive value of 91 per cent. CT scanning without rectal contrast is effective for the diagnosis of acute appendicitis making rectal contrast, with its attendant morbidity, unnecessary. The previously acceptable published negative appendectomy rate is higher than that found in current surgical practice likely due to preoperative CT scanning.

Appendicoliths: the neglected stones

2017 ◽  
Vol 4 (1) ◽  
pp. 3-6
Author(s):  
Saroj Dhital ◽  
Udaya Koirala ◽  
Birendra Dhoj Joshi ◽  
Amit Mani Upadhyaya ◽  
Arbin Joshi
Keyword(s):  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Vermiform Appendix ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Recurrent Appendicitis ◽  
Right Iliac Fossa Pain

Introductions: Cases of colic of the vermiform appendix have been rarely described or diagnosed. Appendicoliths cause acute appendicitis and appendicular perforation. It is still not clear whether appendicoliths cause appendicular colic in the absence of acute appendicitis. Methods: A cross sectional study that included appendectomy done for recurrent appendicitis or chronic right iliac fossa pain. Histology reports were reviewed. The presence of an appendicolith in the report was noted. Results: Thirty-two cases of recurrent appendicitis and chronic right iliac fossa pain were included. Twenty-four patients (75%) had fecoliths in the histology specimens. Eight patients (25%) who presented with appendicular colic without signs of appendicitis were further evaluated. Conclusions: Majority of patients with chronic or colicky right iliac fossa pain had appendicoliths.

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