Accuracy of ultrasonography for diagnosis of pediatric acute appendicitis: The experience of a Senegalese tertiary hospital

Abstract Aim Coronavirus (COVID) has influenced the management of acute appendicitis. The Royal Colleges of Surgeons recommend best practice depending on local circumstances. The aim of this project is to assess the 30-day outcome of patients managed operatively and conservatively for acute appendicitis during the first wave of the pandemic in the UK. Method Patient data were collected prospectively at the end of March 2020, when Covid-19 became prevalent in the UK and lockdown started. Data was collected for patients admitted to the acute surgical unit for the admission dates of 20/03/2020 to 15/05/2020. At 30 days after admission, a search was done on the electronic clinical portal to check if the patient was readmitted for operation. The inclusion criteria are any patients above 16-year-old admitted through acute surgical unit with a clinical diagnosis of acute appendicitis or computed tomography scan findings of proven acute appendicitis. Result A total of 34 patients (median age, 33; range, 17-74) were identified from March 2020 to May 2020. All patients have covid-19 status as negative and were given intravenous antibiotics at point of admission. All patients received a course of seven-day of antibiotic. 17 patients underwent operation and 17 patients were managed conservatively. Only one patient who was treated conservatively for acute appendicitis, was re-admitted within 30 days of admission date. Discussion The readmission rate of patients treated conservatively for acute appendicitis after 30 days were low during the first wave of the pandemic.

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Predictors and Outcomes of Nondiagnostic Ultrasound for Acute Appendicitis in Children

The American Surgeon ◽

10.1177/000313481708301218 ◽

2017 ◽

Vol 83 (12) ◽

pp. 1357-1362 ◽

Cited By ~ 1

Author(s):

Richard Sola ◽

Blair A. Wormer ◽

William E. Anderson ◽

Thomas M. Schmelzer ◽

Graham H. Cosper

Keyword(s):

Acute Appendicitis ◽

Blood Cell ◽

White Blood Cell ◽

Tertiary Hospital ◽

Pediatric Emergency ◽

Reactive Protein ◽

Management Algorithm ◽

Computed Tomography Scans ◽

After Hours ◽

Hospital Pediatric

Ultrasound assessments of children with possible acute appendicitis (AA) are often nondiagnostic. We aimed to identify the predictors of nondiagnostic ultrasound and to investigate the outcomes. A retrospective review was conducted on children aged 4 to 17 years evaluated in 2013 for AAwith ultrasound at a tertiary hospital pediatric emergency department. Demographics, clinical data, and outcomes were analyzed. Of 528 children, 194 (36.7%) had diagnostic ultrasounds and 334 (63.3%) had nondiagnostic ultrasounds. Nondiagnostic ultrasounds were more common after-hours (7 pm–7 am weekdays and on weekends, 70.7%) than during business hours (7 am–7 pm weekdays; 29.3%). After-hours timing and female sex were identified as independent predictors of non-diagnostic ultrasounds (P < 0.05 for both). AA was diagnosed in 35 children with a nondiagnostic ultrasound (10.5%; P < 0.05). No child who underwent a nondiagnostic ultrasound was found to have AA with laboratory values of white blood cell < 11 x 103/μL and c-reactive protein (CRP) < 5 mg/dL. Children with nondiagnostic ultrasounds have a low likelihood of AA if white blood cell < 11 and CRP < 5. We propose a management algorithm that we hope will help reduce admissions and decrease the use of computed tomography scans.

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Diagnostic accuracy of acute appendicitis by comparing clinical judgment of surgeons and Alvarado scoring in suspected acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20213603 ◽

2021 ◽

Vol 8 (9) ◽

pp. 2725

Author(s):

Ishory Bhusal ◽

Chandra Shekhar Agarwal ◽

Rakesh Kumar Gupta ◽

Suresh Prasad Sah

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Clinical Judgment ◽

Scoring System ◽

Randomized Study ◽

Tertiary Hospital ◽

Alvarado Score ◽

Suspected Appendicitis ◽

Group A ◽

Group B

Background: The Alvarado score is a clinical scoring system used in the diagnosis of acute appendicitis. The aim of the study was to compare the clinical judgment of surgeons and Alvarado score in diagnosing acute appendicitis within Nepalese people and to refine the score and suggest a new score to make a more accurate diagnosis of acute appendicitis.Methods: In this prospective, parallel-group, quasi-randomized study of patients presenting at a tertiary hospital in eastern Nepal with suspected appendicitis during 1 year were assigned in weekly alternation to either group A or group B. The group A patients were treated on the basis of their Alvarado score, and the group B patients based on the clinical judgment. The correctness of the methods was assessed by the final histology.Results: In this study, the mean age of patients in Alvarado group was 26.45 years and in clinical judgment was 28.68 years. The sensitivity, the specificity, the diagnostic accuracy, the positive predictive value and negative appendectomies in Alvarado group were 95.5%, 68.9%, 90.91%, 93.4% and 6.56% respectively whereas in clinical judgment group were 98.51%, 85.71%,496.4%, 97.04% and 3.59% respectively.Conclusions: This study showed clinical judgment to be more reliable in the diagnosis of acute appendicitis than the Alvarado score, but the score is a useful diagnostic aid, especially for young colleagues. The use of the new scoring system has become easier. It includes fewer criteria as well as an important and sensitive predictor: the ultrasound investigation.

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Angiocentric lymphoma masquerading as acute appendicitis

Histopathology ◽

10.1046/j.1365-2559.1999.0669f.x ◽

1999 ◽

Vol 34 (4) ◽

pp. 378-380 ◽

Cited By ~ 2

Author(s):

Huh ◽

S-M Hong ◽

Kim ◽

B-S Kim ◽

K-H Lee ◽

...

Keyword(s):

Acute Appendicitis ◽

Angiocentric Lymphoma

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Abstract #130: A Patient with Undiagnosed Paraganglioma Presenting with Acute Appendicitis

Endocrine Practice ◽

10.1016/s1530-891x(20)44304-6 ◽

2017 ◽

Vol 23 ◽

pp. 18

Author(s):

Roja Fallah

Keyword(s):

Acute Appendicitis

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Surgery for Acute Appendicitis May Be Delayed

Hospitalist News ◽

10.1016/s1875-9122(10)70250-9 ◽

2010 ◽

Vol 3 (10) ◽

pp. 10

Author(s):

MARY ANN MOON

Keyword(s):

Acute Appendicitis

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Schistosomal Appendicitis in Pregnancy

Swiss Surgery ◽

10.1024/1023-9332.8.3.121 ◽

2002 ◽

Vol 8 (3) ◽

pp. 121-122 ◽

Cited By ~ 9

Author(s):

Halkic ◽

Abdelmoumene ◽

Gintzburger ◽

Mosimann

Keyword(s):

Acute Appendicitis ◽

Schistosoma Haematobium ◽

Acute Inflammation ◽

The Body ◽

Parasitic Infections ◽

Common Complication ◽

Surgical Infection ◽

High Prevalence ◽

Potential Challenge ◽

In Pregnancy

Acute appendicitis is the most common acute surgical infection during pregnancy. Although usually pyogenic in origin, parasitic infections account for a small percentage of cases. Despite the relatively high prevalence of acute appendicitis in our environment, it is not commonly associated with schistosomiasis. We report here the association of pregnancy and appendicitis caused by Schistosoma haematobium. Schistosomiasis is very common complication of pregnancy in hyperendemic areas. Schistosome egg masses can lodge throughout the body and cause acute inflammation of the appendix, liver and spleen. Congestion of pelvic vessels during pregnancy facilitates passage of eggs into the villi and intervillous spaces, causing an inflammatory reaction. Tourism and immigration make this disease a potential challenge for practitioners everywhere.

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Clinical and Imaging Mimickers of Acute Appendicitis in the Pediatric Population

Yearbook of Diagnostic Radiology ◽

10.1016/s0098-1672(08)70113-9 ◽

2007 ◽

Vol 2007 ◽

pp. 156-159

Author(s):

A.E. Oestreich

Keyword(s):

Acute Appendicitis ◽

Pediatric Population

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Improving diagnosis of acute appendicitis with atypical findings by Tc-99m HMPAO leukocyte scan

Nuklearmedizin ◽

10.1055/s-0038-1623994 ◽

2002 ◽

Vol 41 (01) ◽

pp. 37-41 ◽

Cited By ~ 3

Author(s):

S. Shung-Shung ◽

S. Yu-Chien ◽

Y. Mei-Due ◽

W. Hwei-Chung ◽

A. Kao

Keyword(s):

Acute Appendicitis ◽

False Positive ◽

False Positive Rate ◽

Accurate Method ◽

Clinical Findings ◽

Pathological Findings ◽

Lower Quadrant ◽

Predictive Values ◽

Positive Rate

Summary Aim: Even with careful observation, the overall false-positive rate of laparotomy remains 10-15% when acute appendicitis was suspected. Therefore, the clinical efficacy of Tc-99m HMPAO labeled leukocyte (TC-WBC) scan for the diagnosis of acute appendicitis in patients presenting with atypical clinical findings is assessed. Patients and Methods: Eighty patients presenting with acute abdominal pain and possible acute appendicitis but atypical findings were included in this study. After intravenous injection of TC-WBC, serial anterior abdominal/pelvic images at 30, 60, 120 and 240 min with 800k counts were obtained with a gamma camera. Any abnormal localization of radioactivity in the right lower quadrant of the abdomen, equal to or greater than bone marrow activity, was considered as a positive scan. Results: 36 out of 49 patients showing positive TC-WBC scans received appendectomy. They all proved to have positive pathological findings. Five positive TC-WBC were not related to acute appendicitis, because of other pathological lesions. Eight patients were not operated and clinical follow-up after one month revealed no acute abdominal condition. Three of 31 patients with negative TC-WBC scans received appendectomy. They also presented positive pathological findings. The remaining 28 patients did not receive operations and revealed no evidence of appendicitis after at least one month of follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values for TC-WBC scan to diagnose acute appendicitis were 92, 78, 86, 82, and 90%, respectively. Conclusion: TC-WBC scan provides a rapid and highly accurate method for the diagnosis of acute appendicitis in patients with equivocal clinical examination. It proved useful in reducing the false-positive rate of laparotomy and shortens the time necessary for clinical observation.

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