scholarly journals Incidence of Negative Appendicectomy: Correlation Between Clinical, Peroperative and Histopathological Findings

2017 ◽  
Vol 42 (3) ◽  
pp. 142-146
Author(s):  
Mohammad Zillur Rahman ◽  
Johirul Islam ◽  
Md. Hasanuzzaman ◽  
Ahsan Habib ◽  
Avisak Bhattachari
Keyword(s):  
Acute Appendicitis ◽  
Correct Diagnosis ◽  
Reproductive Age ◽  
Histological Evaluation ◽  
Diagnostic Tools ◽  
Histopathological Findings ◽  
Suspected Appendicitis ◽  
Female Patients ◽  
Male Patients ◽  
Negative Appendicectomy

Appendicitis is one of the most difficult diagnostic problems to confront the emergency physician and it is the most common intra-abdominal condition requiring emergency surgery. The term “Negative appendicectomy” used for operation done for suspected appendicitis, in which the appendix is found to be normal on histological evaluation. The study aimed to find out the incidence of negative appendicectomy evaluating the correlation between clinical, per-operative and histopathological findings. It was a prospective study of 100 cases clinically diagnosed as acute appendicitis selected over a period of one year (July 2006 to June 2007) from different surgical ward of Mymensingh Medical College Hospital. The study revealed a negative appendicectomy rate of 12%. Moreover, in all cases of acute appendicitis, there was a well established bias towards male patients and young male patients constituted the majority of the cases. But the rate of negative appendicectomy found to be higher in female patients, which is 15.9% as compared to only 8.92% male patients. In addition, among female patients differential diagnostic difficulties encountered in females of reproductive age group. More emphasis on technology at the expense of clinical evaluation is certainly responsible for the diminish in accuracy of diagnosis. The diagnosis of acute appendicitis remains essentially clinical, requiring a mixture of observation, clinical acumen and accurate use of diagnostic tools.  A correct diagnosis is certainly important than a rapid diagnosis.

EP.FRI.615 Assessing the reliability of the Adult Appendicitis Score in managing patients with suspected acute appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Carry Zheng ◽  
Shiela Lee ◽  
Steven Brown ◽  
Venkat Kanakala
Keyword(s):  
Acute Appendicitis ◽  
Risk Group ◽  
Pathological Finding ◽  
High Risk Group ◽  
Histological Diagnosis ◽  
Suspected Appendicitis ◽  
Tertiary Centre ◽  
Negative Appendicectomy ◽  
Age Range ◽  
Suspected Acute Appendicitis

Abstract Aims To evaluate the effectiveness of using a clinical prediction tool in the management of suspected acute appendicitis Methods Retrospective data was collected on patients undergoing appendicectomy at a single tertiary centre from November 2019 to June 2020. Inclusion criteria were all patients aged 18 and above undergoing diagnostic laparoscopy for suspected appendicitis. Exclusion criteria were all patients that had a pathological finding other than appendicitis at laparoscopy. The pre operative AAS score at first presentation was calculated and patients grouped into low(0-10), intermediate(11-15), and high(16 and above) risk. These groups were then compared to the histological findings. Results A total of 74 patients were included, 44 male and 30 female. The age range was from 18 to 83, with a median age of 36. Of 10 patients in the low risk group, 4 (40%) had appendicitis on histology. 36 out of 40 (90%) patients in the intermediate risk group had appendicitis and 100% of the 24 patients in the high risk group. Pearson’s coefficient showed a significant correlation between the AAS risk (low, intermediate, and high) and the histological diagnosis of appendicitis (r = 0.48, p = 0.000016). Conclusions Our study did show a positive correlation between the AAS risk stratification and histological diagnosis. Based on our findings we would recommend the adoption of this score in assessing patients with suspected acute appendicitis and minimising the negative appendicectomy rate.

scholarly journals Comparison of Clinical Features Between Patients with Positive and Negative Appendectomy

2020 ◽  
Author(s):  
Guner Cakmak ◽  
Baris Mantoglu ◽  
Emre Gonullu ◽  
Kayhan Ozdemir ◽  
Burak Kamburoglu
Keyword(s):  
Acute Appendicitis ◽  
Clinical Features ◽  
Total Bilirubin ◽  
Negative Appendectomy ◽  
C Reactive Protein ◽  
Future Studies ◽  
Female Patients ◽  
Reactive Protein ◽  
Male Patients ◽  
The Mean

Abstract Background: The objective of this study was to retrospectively compare clinical features and prognostic values between the patients who were referred to the general surgery clinic of our hospital with the presumed diagnosis of acute appendicitis and underwent positive or negative appendectomy.Methods: Patients were divided into two groups as positive (PA) (n:362) and negative appendectomy (NA) (n:284) and the data obtained were compared between these two groups.Laboratory investigations were performed in all patients, and white blood cell (WBC), mean platelet volume (MPV), neutrophils count (NEU), neutrophils (%) (NEU%), C-reactive protein (CRP) and total bilirubin (TBIL) values were studied.Results: The mean MPV value was found as 7.88 fl in PA groups and 8.09 fl in NA group, and the mean MPV value was not statistically significantly difference in PA group, compared to NA groups (p=0.012). Laboratory parameters were also compared between genders. Accordingly, the mean MPV value was statistically significantly higher in female patients compared to male patients in PA group (p = 0.04). The mean TBIL value was 0.97 mg/dl in PA group and 0.69 mg/dl in NA group, and the mean TBIL value was statistically significantly higher in PA group (p< 0.001). Finally, TBIL value was statistically significantly lower in female patients compared to male patients in NA and PA group (p < 0.05).Conclusions: According to the results of our study, MPV and T. BIL values differ in PA and NA groups depending on gender. Therefore, these values may not be used as specific biomarkers in predicting positive acute appendicitis. We believe that these results will contribute to the literature and will be guiding for future studies.

scholarly journals ANGKA KEJADIAN APENDISITIS DI RSUP PROF. DR. R. D. KANDOU MANADO PERIODE OKTOBER 2012 – SEPTEMBER 2015

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Gloria A. Thomas ◽  
Ishak Lahunduitan ◽  
Adrian Tangkilisan
Keyword(s):  
Acute Appendicitis ◽  
Acute Inflammation ◽  
Perforated Appendicitis ◽  
Vermiform Appendix ◽  
Clinical Decision ◽  
Chronic Appendicitis ◽  
Suspected Appendicitis ◽  
Male Patients ◽  
Using Data ◽  
Age Range

Abstract: Appendicitis is an inflammation of vermiform appendix. Acute inflammation of the appendix needs to be treated immediately to prevent fatal complications. The incidence among females and males is slightly comparable, however, the incidence is higher among males than females in the age range between 20-30 years. The fundamental clinical decision in the diagnosis of a patient with suspected appendicitis is whether to do an operation or not. The meaningful evaluation of acute appendicitis balances early operative intervention to prevent operative risks. This study aimed to obtain the incidence of appendicitis at Prof. Dr. R.D Kandou Hosiptal Manado from October 2012 to September 2015. This was a  retrospective descriptive study using data of the Department of Medical Record Prof. Dr. R.D Kandou Manado Hospital. The results showed that there were 650 patients. Most patients had acute appendicitis as many as 412 patients (63%) meanwhile chronic appendicitis was found in 38 patients (6%). Of 650 patients, 200 patients had complications; 193 patients (30%) with perforated appendicitis and 7 patients (1%) with appendicular mass. The most frequent age group to develop appendicitis was 20-29 years. The number of male patients was higher than the females. Keywords: appendicitis, incidence  Abstrak: Apendisitis adalah adanya peradangan pada apendiks vermiformis. Peradangan akut pada apendiks memerlukan tindak bedah segera untuk mencegah komplikasi yang umumnya berbahaya. Insidens pada perempuan dan laki-laki umumnya sebanding, kecuali pada umur 20-30 tahun insidens pada laki-laki lebih tinggi. Keputusan klinis mendasar dalam mendiagnosis pasien dengan dugaan apendisitis ialah apakah perlu dilakukannya operasi atau tidak.  Evaluasi yang baik dari kasus apendisitis akut dapat mengurangi intervensi untuk operasi awal, dengan harapan dapat mengurangi risiko operasi yang tidak diperlukan. Penelitian ini bertujuan untuk mengetahui angka kejadian apendisitis di RSUP Prof. Dr. R. D, Kandou Manado periode Oktober 2012 – September 2015. Metode penelitian yang digunakan ialah deskriptif retrospektif dengan menggunakan data di Bagian Rekam Medik RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian menunjukkan bahwa selama periode Oktober 2012 – September 2015 terdapat 650 pasien. Jumlah pasien terbanyak ialah apendisitis akut yaitu 412 pasien (63%) sedangkan apendisitis kronik sebanyak 38 pasien (6%). Dari 650 pasien, yang mengalami komplikasi sebanyak 200 pasien yang terdiri dari 193 pasien (30%) dengan komplikasi apendisitis perforasi dan 7 pasien (1%) dengan periapendikuler infiltrat. Kelompok umur tersering yang menderita apendisitis ialah 20-29 tahun. Jumlah pasien laki-laki lebih banyak daripada perempuan. Kata kunci: apendisitis, angka kejadian  

scholarly journals Negative Appendectomy Rate in Urban Referral Hospitals in Tanzania: A Cross-sectional Analysis of Associated Factors

2021 ◽  
Vol 18 (2) ◽  
pp. 109-114
Author(s):  
Masawa Klint Nyamuryekung’E ◽  
Ali Athar ◽  
Miten Ramesh Patel ◽  
Aidan Njau ◽  
Omar Sherman ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Associated Factors ◽  
Lifetime Risk ◽  
Histological Evaluation ◽  
Negative Appendectomy ◽  
Perforation Rate ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Referral Hospitals ◽  
Negative Appendectomy Rate

Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negativeappendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania. Methods: This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for  suspected AA with histological evaluation of specimens. The study was powered to detect the NAR at 95% confidence level and 80% power. Results: The histological NAR was 38.5% and the perforation rate was 25.3%. The Alvarado score (AS) was rarely applied (6%), despite ademonstrated ability in this study to decrease the NAR by half. Females were four times more likely to undergo negative appendectomy than males. Conclusion: The NAR is clinically significant as about two out of every five patients undergoing emergency appendectomy for suspected AA do not require the procedure. The AS is underutilized despite a demonstrated ability to decrease the NAR. We recommend that the AS be incorporated in the management of patients with suspected appendicitis. Keywords: Negative appendectomy rate, SubSaharan Africa, Alvarado score, Appendectomy, Suspected acute appendicitis

scholarly journals A comparison of intra-operative diagnosis to histopathological diagnosis of acute appendicitis in paediatric and adult cohorts: an analysis of over 1000 patients

2021 ◽  
Author(s):  
Johnathon Harris ◽  
Christina A. Fleming ◽  
Paul N. Stassen ◽  
Daniel Mullen ◽  
Helen Mohan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Diagnosis ◽  
Open Appendicectomy ◽  
Normal Appendix ◽  
Macroscopic Appearance ◽  
Surgical Department ◽  
Suspected Appendicitis ◽  
Final Histological Diagnosis ◽  
Negative Appendicectomy ◽  
Operating Surgeon

Abstract Background Appendicitis is a common general surgical emergency. The role of removing a normal appendix is debated. However, this relies on accurate intra-operative diagnosis of a normal appendix by the operating surgeon. This study aimed to compare surgeon’s intra-operative assessment to final histological result acute appendicitis in paediatric and adult patients. Methods All patients who underwent appendicectomy over a 14-year period in a general surgical department were identified using the prospective Lothian Surgical Audit system and pathology reports retrieved to identify final histological diagnosis. Open appendicectomy was selected to examine, as the routine practise at our institution is to remove a normal appendix at open appendicectomy. Results A total of 1035 open appendicectomies were performed for clinically suspected appendicitis. Sensitivity of intra-operative diagnosis of appendicitis with operating surgeon was high at 95.13% with no difference between trainee and consultant surgeon or between adult and paediatric cases. Specificity of intra-operative diagnosis was lower in the paediatric group (32.58%) than in the adult group (40.58%). Women had a higher rate of negative appendicectomy than men. Conclusion The results of this study highlight some discordance between histological evidence of acute appendicitis and intra-operative impression. Therefore other clinical variables and not just macroscopic appearance alone should be used when deciding to perform appendicectomy.

scholarly journals ACUTE APPENDICITIS;

2014 ◽  
Vol 21 (06) ◽  
pp. 1139-1143
Author(s):  
Zahid Saeed
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Acute Abdomen ◽  
Carcinoid Tumour ◽  
Diagnostic Tools ◽  
Associated Conditions ◽  
Proper Diagnosis ◽  
Negative Appendicectomy ◽  
Appendiceal Inflammation ◽  
Time Of Presentation

Background: Acute appendicitis is the commonest cause of acute abdomen presenting in emergency room, which is mainly diagnosed on clinical grounds. Objective: To determine the diagnostic accuracy in patient of acute appendicitis and to review the pathological diagnosis. Material and Method: A retrospective study was conducted at PNS SHIFA hospital at Karachi; from May 2012 to April 2013. A total of 120 patients were included in the study who presented with acute abdomen and clinically diagnosed as acute appendicitis. Emergency appendectomy was done in all consecutive subjects and intra operative finding along with histo-pathological reports were compared with clinical diagnosis. Results: A total of 120 patients were included in the study who underwent appendicectomy during this period. The majority of our patients were in the age group between 15-30 years (66.5%) and presented within 24 h of onset of symptoms. The most common symptoms were abdominal pain (100%), vomiting (57.4%) and anorexia (49.0%). Pyrexia was noted in 41.0%.Localized abdominal tenderness with positive release sign was mainly present. The most common incision was gridiron (57.2%) followed by Lanz (37.3%) and in remaining Rutherford Morrison incision was made. Acute appendiceal inflammation and gangrenous appendicitis was present in 67% and 13%, respectively. The perforation rate was 5.0% and there was a direct correlation with time of presentation. There were no patients with carcinoid tumour or adenocarcinoma. Parasites and other associated conditions were seen in 3 % of cases. On the basis of histo-pathological report, 84% were found to have acute appendicitis with negative appendicectomy rate of 16.0%. Conclusions: Clinical surgical skill is good enough to diagnose acute appendicitis but auxiliary diagnostic tools can help to elevate the diagnostic accuracy,but these are not 100% accurate and at times may not be available.So clinial good judgement is essential for proper diagnosis and that can be confirmed by histopathology report.

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 ALVARADO SCORE;

2012 ◽  
Vol 20 (01) ◽  
pp. 001-005
Author(s):  
SHAFAQAT ALI ◽  
ZAKA ULLAH MALIK ◽  
M. MUTTAHHAR ASIM NIAZ ◽  
Naveed Ahmed
Keyword(s):  
Acute Appendicitis ◽  
Gold Standard ◽  
Alvarado Score ◽  
Cross Sectional ◽  
Female Ratio ◽  
Group I ◽  
Male Patients ◽  
Group Ii ◽  
Negative Appendicectomy ◽  
Hospital Group

Objective: To determine the validity of Alvarado score in diagnosing acute appendicitis keeping histopathology of appendixas gold standard. Study Design: Cross sectional (Validation) study. Place and Duration of Study: Department of Surgery CombinedMilitary Hospital Rawalpindi from April 2009 to October 2009. Materials and Methods: 90 patients with clinical suspicion/diagnosis ofacute appendicitis were included in study. All were divided into two groups on the basis of Alvarado score. Group I with score 7-10, whounderwent open appendicectomy. Group II(a) with 5-6, who were observed in hospital. Group II(b) with< 4 were discharged. In alloperated cases appendix was sent for histopathology. Alvarado score was compared with histopathology (gold standard). Results: Maleto female ratio was 3.5 :1. Mean age was 25.34. Alvarado score had overall 88.13% sensitivity, 70.96% specificity, 85.24% PPV,75.86%NPV and 16.90% negative appendicectomy rate. Whereas in male patients it had 90.74% sensitivity, 75% specificity, 92.45%PPV,70.58%NPV and 6.89% negative appendicectomy rate. In female it had 60% sensitivity, 66.66% specificity, 37.5% PPV, 83.33%NPV and38.46% negative appendicectomy rate. Conclusion: Alvarado score is very accurate for acute appendicitis in male patients. Patients withscore 4 can safely be discharged home. USG should be performed routinely in female patients to improve the diagnostic accuracy ofAlvarado score.

scholarly journals Comparison of Alvarado and RIPASA scoring systems in diagnosis of acute appendicitis and correlation with intraoperative and histopathological findings

2017 ◽  
Vol 4 (5) ◽  
pp. 1755 ◽  
Author(s):  
Mahendra Kumar Regar ◽  
Ganpat Singh Choudhary ◽  
Chandrakanta Nogia ◽  
Dharmendra Kumar Pipal ◽  
Anand Agrawal ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Examination ◽  
Scoring Systems ◽  
Exclusion Criterion ◽  
P Value ◽  
Chi Square ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Histopathological Findings ◽  
Negative Appendicectomy

Background: Despite extraordinary advances in modern radiology and laboratory investigations an accurate diagnosis of acute appendicitis cannot be made in atypical cases. No single diagnostic aid can dramatically reduce the rate of negative appendicectomy.Methods: To reduce the rate of negative appendicectomies, application of RIPASA and Alvarado scoring done in every clinically diagnosed cases of appendicitis in a prospective study from January 2015 to January 2016 was done. 100 patients with right lower quadrant abdominal pain fulfilling the inclusion and exclusion criterion underwent appendicectomy in Mahatma Gandhi Hospital, Dr. S.N. Medical college, Jodhpur, Rajasthan, India.Results: The results of both scoring system were reported and were correlated with intraoperative and histopathological findings. Chi-square test was applied to calculate the p-value for the association between the variables of studied. The mean age was 24.86 years (10-80 years) and there were 61 males and 39 females in the study. Histopathological examination confirmed appendicitis in 95 patients with 5 negative appendicectomies. Negative appendicectomy rate for RIPASA and Alvarado score was 2.17% and 1.54% respectively. Accuracy for RIPASA and Alvarado score was 93% and 68% respectively.Conclusions: RIPASA score is a more valuable tool for diagnosing acute appendicitis with 93% accuracy, sensitivity 94.74% and specificity 60%; inspite of sophisticated investigations like CT, thus reducing the cost of treatment and minimize negative appendicectomy rate.

scholarly journals HUBUNGAN STATUS GIZI DENGAN BERAT RINGANNYA CAMPAK PADA ANAK

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Teressa S. Liwu ◽  
Novie H. Rampengan ◽  
Suryadi N. N. Tatura
Keyword(s):  
Acute Appendicitis ◽  
Acute Inflammation ◽  
Perforated Appendicitis ◽  
Vermiform Appendix ◽  
Clinical Decision ◽  
Chronic Appendicitis ◽  
Suspected Appendicitis ◽  
Male Patients ◽  
Using Data ◽  
Age Range

Abstract: Appendicitis is an inflammation of vermiform appendix. Acute inflammation of the appendix needs to be treated immediately to prevent fatal complications. The incidence among females and males is slightly comparable, however, the incidence is higher among males than females in the age range between 20-30 years. The fundamental clinical decision in the diagnosis of a patient with suspected appendicitis is whether to do an operation or not. The meaningful evaluation of acute appendicitis balances early operative intervention to prevent operative risks. This study aimed to obtain the incidence of appendicitis at Prof. Dr. R.D Kandou Hosiptal Manado from October 2012 to September 2015. This was a  retrospective descriptive study using data of the Department of Medical Record Prof. Dr. R.D Kandou Manado Hospital. The results showed that there were 650 patients. Most patients had acute appendicitis as many as 412 patients (63%) meanwhile chronic appendicitis was found in 38 patients (6%). Of 650 patients, 200 patients had complications; 193 patients (30%) with perforated appendicitis and 7 patients (1%) with appendicular mass. The most frequent age group to develop appendicitis was 20-29 years. The number of male patients was higher than the females. Keywords: appendicitis, incidence  Abstrak: Apendisitis adalah adanya peradangan pada apendiks vermiformis. Peradangan akut pada apendiks memerlukan tindak bedah segera untuk mencegah komplikasi yang umumnya berbahaya. Insidens pada perempuan dan laki-laki umumnya sebanding, kecuali pada umur 20-30 tahun insidens pada laki-laki lebih tinggi. Keputusan klinis mendasar dalam mendiagnosis pasien dengan dugaan apendisitis ialah apakah perlu dilakukannya operasi atau tidak.  Evaluasi yang baik dari kasus apendisitis akut dapat mengurangi intervensi untuk operasi awal, dengan harapan dapat mengurangi risiko operasi yang tidak diperlukan. Penelitian ini bertujuan untuk mengetahui angka kejadian apendisitis di RSUP Prof. Dr. R. D, Kandou Manado periode Oktober 2012 – September 2015. Metode penelitian yang digunakan ialah deskriptif retrospektif dengan menggunakan data di Bagian Rekam Medik RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian menunjukkan bahwa selama periode Oktober 2012 – September 2015 terdapat 650 pasien. Jumlah pasien terbanyak ialah apendisitis akut yaitu 412 pasien (63%) sedangkan apendisitis kronik sebanyak 38 pasien (6%). Dari 650 pasien, yang mengalami komplikasi sebanyak 200 pasien yang terdiri dari 193 pasien (30%) dengan komplikasi apendisitis perforasi dan 7 pasien (1%) dengan periapendikuler infiltrat. Kelompok umur tersering yang menderita apendisitis ialah 20-29 tahun. Jumlah pasien laki-laki lebih banyak daripada perempuan. Kata kunci: apendisitis, angka kejadian

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