scholarly journals Accuracy of Ultrasound in the Diagnosis of Acute Appendicitis and Correlation with Histopathology

2018 ◽  
Vol 8 (2) ◽  
pp. 13-19
Author(s):  
Aimandu Shrestha ◽  
Hensan Khadka ◽  
Baburam Poudel ◽  
Ranga Bahadur Basnet ◽  
Siv Bahadur Basnet
Keyword(s):  
Acute Appendicitis ◽  
Leukocyte Count ◽  
Total Leukocyte Count ◽  
Radiology Department ◽  
Clinical Impression ◽  
Negative Appendectomy ◽  
Differential Leukocyte Count ◽  
Diagnostic Modality ◽  
Predictive Values ◽  
Negative Appendectomy Rate

Introduction: Acute appendicitis is a common surgical condition; yet its diagnosis can be elusive at times and missed diagnosis can lead to attendant complications of perforation and its sequelae. On the contrary, negative appendectomy subjects one to unnecessary surgery and its physiological and psychological consequences. Among the various available modalities of diagnosis of appendicitis, Ultrasonography(USG) is easily accessible, non invasive, less time consuming, low cost investigation no radiation hazards. So, USG is appropriate diagnostic modality in our country.Methods: This prospective observational study was carried out from January 2011 to June 2011, in the radiology department of Bir hospital. Total of 80 cases with clinical impression of acute appendicitis were enrolled. These patients underwent surgery for suspected acute appendicitis. Details of signs and symptoms, lab findings including Total Leukocyte count (TLC), Differential Leukocyte Count (DLC) and USG findings were recorded. Intra-operative and histopathology findings were also recorded. The findings were analyzed to assess accuracy of ultrasonography in acute appendicitis. Histopathological report was considered the goal standard.Results: A total of 93 cases clinically diagnosed as acute appendicitis were subjected for USG. Out of 93 cases, 80 cases underwent surgery. Among 80 cases, sonography showed acute appendicitis in 56 cases out of which 54 was proved by histopathology as well. However, ultrasonography was not able to detect appendicitis in 9 cases. The sensitivity and specificity of USG for acute appendicitis were 87.7% and 88.2% respectively. The positive and negative predictive values were 96.4% and 62.5% respectively. Overall negative appendectomy rate of 21.2% had been used a basis for decision making, the rate of error being 13.7%.Conclusion: Ultrasonography is a fairly accurate and safe modality in acute appendicitis. It can be useful in reducing negative appendectomy rate.

scholarly journals A study to find out correlation between clinical diagnosis and histopathological diagnosis in patients with acute appendicitis undergoing surgical treatment

2019 ◽  
Vol 6 (6) ◽  
pp. 2046
Author(s):  
Mohit Jain ◽  
Yogesh Kumar Sharma
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Scoring System ◽  
Emergency Operation ◽  
Negative Appendectomy ◽  
Histopathological Diagnosis ◽  
Complication Rates ◽  
Diagnostic Modality ◽  
Negative Appendectomy Rate ◽  
A Prospective Study

Background: Acute appendicitis is one of the most frequent abdominal emergencies and appendectomy subsequently the most common emergency operation performed all over the world. The aim of the study is to evaluate the reliability of Clinical Diagnosis for diagnosis of acute appendicitis and correlate it with the gold standard and absolute diagnostic modality, histopathology.Methods: This is a prospective study carried out in 150 patients who were admitted under department of surgery, AFMC Pune, Maharashtra from 1st July 2014 to 31st June 2016 for a clinical diagnosis of acute appendicitis.Results: In our study overall negative appendectomy rate was 18.7% (12.37% in male and 30.19% in female). Hence in the overall females had more negative appendectomy rate compared to males. In our series a score of >7 using Alvarado system had a total sensitivity of 72.95%. While sensitivity increases to 99.18% when score of >5 used as cut-off.Conclusions:Alvarado scoring system is beneficial in decreasing negative appendectomy rate and thus reduces complication rates. It is effective in the diagnosis of acute appendicitis in both men and females but some other diagnostic modality may be necessary to ascertain the diagnosis in females along with the clinical scoring system to rule out other pelvic pathology and to reduce negative appendectomy rate in females. 

scholarly journals Alvarado Score: still relevant in diagnosis of acute appendicitis: a prospective study with histopathological correlation

2017 ◽  
Vol 4 (7) ◽  
pp. 2123
Author(s):  
Rushil Jain ◽  
Vimal Jain ◽  
Shalit Jolly
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Examination ◽  
Imaging Techniques ◽  
Clinical History ◽  
Negative Appendectomy ◽  
Emergency Setting ◽  
Likelihood Ratios ◽  
Alvarado Score ◽  
Predictive Values ◽  
Negative Appendectomy Rate

Background: Acute appendicitis is the most common abdominal emergency. Although abdominal surgeons have been encountering the acute appendicitis for more than 100 years, prompt diagnosis is still elusive in order to reduce morbidity and to avoid serious complications. Present study was conducted to evaluate the usefulness of Alvarado score in diagnosing acute appendicitis and its role in minimizing the negative appendectomy rate and correlating the same with histopathological findings of appendectomy specimens.Methods: This prospective correlational study was conducted in the Department of General Surgery, Mata Chanan Devi Hospital, New Delhi for a period of one year from January 2014 to December2014.Complete clinical history of the patients was collected in a predesigned proforma.  A complete physical and systemic examination was done for all patients. Based on the Alvarado scoring system the patients were divided into three categories. Category 1 (score ranging from 1-4), Category 2 (score ranging from 5-6), Category 3 (score ranging from 7-10). Specimen of removed appendix was sent for histopathological examination and clinically correlated those findings with Alvarado score. Sensitivity, specificity, positive negative likelihood ratios, positive and negative predictive values and negative appendectomy rate were calculated.Results: Out of 100 cases (56 males and 44 females) 15 belonged to category-I, 30 belonged to category-II and 55 belonged to category-III. Surgical procedures were done in 67 patients along with conservative management. Final diagnosis by histopathology was found in 58 cases. The sensitivity and specificity of Alvarado score was found to be 89.66% and 92.86% respectively. PPV and NPV of Alvarado score is 94.55% and 86.67% respectively. The negative appendectomy rate was 13.4%.Conclusions: Alvarado score is a simple non-invasive diagnostic procedure, which is reliable, safe, repeatable and economical, easy and can be used in emergency setting, without expensive and complicated supportive diagnostic tool in diagnosing acute appendicitis and thus still very much relevant in today’s modern era with availability of gamut of expensive imaging techniques.

scholarly journals Immune function during pregnancy varies between ecologically distinct populations

2020 ◽  
Vol 2020 (1) ◽  
pp. 114-128
Author(s):  
Carmen Hové ◽  
Benjamin C Trumble ◽  
Amy S Anderson ◽  
Jonathan Stieglitz ◽  
Hillard Kaplan ◽  
...  
Keyword(s):  
Leukocyte Count ◽  
Total Leukocyte Count ◽  
Future Research ◽  
Differential Leukocyte Count ◽  
Ecological Conditions ◽  
Trade Offs ◽  
The Usa ◽  
Immunological Changes ◽  
Fetal Antigens ◽  
Pathogen Exposure

Abstract Background and objectives Among placental mammals, females undergo immunological shifts during pregnancy to accommodate the fetus (i.e. fetal tolerance). Fetal tolerance has primarily been characterized within post-industrial populations experiencing evolutionarily novel conditions (e.g. reduced pathogen exposure), which may shape maternal response to fetal antigens. This study investigates how ecological conditions affect maternal immune status during pregnancy by comparing the direction and magnitude of immunological changes associated with each trimester among the Tsimane (a subsistence population subjected to high pathogen load) and women in the USA. Methodology Data from the Tsimane Health and Life History Project (N = 935) and the National Health and Nutrition Examination Survey (N = 1395) were used to estimate population-specific effects of trimester on differential leukocyte count and C-reactive protein (CRP), a marker of systemic inflammation. Results In both populations, pregnancy was associated with increased neutrophil prevalence, reduced lymphocyte and eosinophil count and elevated CRP. Compared to their US counterparts, pregnant Tsimane women exhibited elevated lymphocyte and eosinophil counts, fewer neutrophils and monocytes and lower CRP. Total leukocyte count remained high and unchanged among pregnant Tsimane women while pregnant US women exhibited substantially elevated counts, resulting in overlapping leukocyte prevalence among all third-trimester individuals. Conclusions and implications Our findings indicate that ecological conditions shape non-pregnant immune baselines and the magnitude of immunological shifts during pregnancy via developmental constraints and current trade-offs. Future research should investigate how such flexibility impacts maternal health and disease susceptibility, particularly the degree to which chronic pathogen exposure might dampen inflammatory response to fetal antigens. Lay Summary This study compares immunological changes associated with pregnancy between the Tsimane (an Amazonian subsistence population) and individuals in the USA. Results suggest that while pregnancy enhances non-specific defenses and dampens both antigen-specific immunity and parasite/allergy response, ecological conditions strongly influence immune baselines and the magnitude of shifts during gestation.

scholarly journals Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

scholarly journals Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

2017 ◽  
Vol 1 ◽  
pp. 1
Author(s):  
Tamer Fakhry ◽  
Mohamed Shawky
Keyword(s):  
Acute Appendicitis ◽  
Imaging Modality ◽  
Radiology Department ◽  
University Hospitals ◽  
Normal Appendix ◽  
Differential Leukocyte Count ◽  
Alvarado Score ◽  
Ultrasound Findings ◽  
Clinical Scoring ◽  
Us Findings

Appendicitis is the most common cause of emergency abdominal surgeries in children. Ultrasound (US) has been proven to be a helpful imaging modality in patient evaluation, especially in children suspected of appendicitis. The Alvarado score is a 10-point scoring system for the diagnosis of appendicitis based on clinical data and differential leukocyte count. The aim of the present study was to evaluate a combination of clinical scoring (Alvarado score) and US findings for accurate diagnosis of appendicitis in children. The study was done in Menoufia University Hospitals from March 2011 to January 2013. 322 children with abdominal pain clinically suspected of having appendicitis were included in the study and clinically assessed to calculate the Alvarado score. Patients were referred to the radiology department for abdominal US. Among the 153 of the 322 patients who were operated on, 149 patients were diagnosed pre-operatively with acute appendicitis and 4 girls were diagnosed with complex ovarian cysts. Of the 149 patients diagnosed with appendicitis, the percentage of appendicitis was 93% (139/149) and 10 (7%) patients had normal appendix. The prevalence of appendicitis among the patients of the study was 43% (139/322). In conclusion, a combination of Alvarado scores and abdominal US is a good approach for the diagnosis of appendicitis in children to reduce the number of laparotomies for normal appendix. In the case of normal appendix or nonvisualization of the appendix via abdominal US without a high Alvarado score, appendicitis can be safely ruled out. If it is proven as an inflamed appendix on US or a high Alvarado score, patient should be subjected for appendectomy without delay.

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.

scholarly journals EP.FRI.960 USS appraisal in females of child bearing age presented with possible appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Fady Hatem ◽  
Samir Mostafa ◽  
Basel Chamali ◽  
Andrea Ivanov ◽  
Rebecca Ross ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Published Data ◽  
Negative Appendectomy ◽  
Child Bearing ◽  
Single Centre Study ◽  
Positive Scan ◽  
Negative Appendectomy Rate ◽  
The Mean ◽  
Low Sensitivity ◽  
The Uk

Abstract Aims Appendicitis remains the most common acute surgical condition.  No standard guidelines for the use of imaging studies, and there is a discrepancy between the published data regarding accuracy of these modalities and our practical findings. Yet the growing number of USS reported as “appendix not visualized” has led us to rethink about the value of USS in acute appendicitis.  Methods A retrospective single centre study for all females (15-45 years) underwent emergency appendectomy for suspected acute appendicitis. Analysis of preoperative clinical, radiographic and postoperative histopathological data was done. Results 632 cases analysed over 18months, out of those 238 (37%) were females (15-45 years). USS was done in 129(54%) cases. 25(10.5) cases had both USS and CTAP. 32(13%) cases had only CTAP. The mean rate of appendix visualization in the USS was 30%(71cases) two thirds reported by radiologist versus one third by sonographers. Our negative appendectomy rate dropped from 25 to 15% after a positive scan.  Conclusions Traditional preference for ultrasound in the UK compared to CTAP in young population is mostly due to the potential hazards of irradiation, but USS commonly does not visualise the appendix in our practice (70%), and has low sensitivity and specificity for appendicitis.  However, following a positive USS, NAR dropped to 15%. Radiologists had a higher visualization rate of appendix compared to sonographers. Commitment to improve the performance of ultrasonography by allocating adequately timed sessions to the most experienced radiologists and increasing the use of low dose CT scans are possible solutions.

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