Rajeev Sharma1, Dev K Kasliwal, Raj G Sharma. 1. Upgraded Department of General Surgery, Sawai Man Singh Medical College, Jaipur, India ; 4 BHA 5 (A), Bank Street, Jawaharnagar, Jaipur, 302 004 India.
Abstract
CONTEXT: Acute appendicitis poses a significant diagnostic challenge to the surgeon. Despite modern advances, the diagnosis of appendicitis remains essentially clinical. Ultrasonography is effective in supplementing the clinical diagnosis. AIMS: This study aims to evaluate the negative appendicectomy rate in patients subjected to appendicectomy and to assess the usefulness of ultrasound in improving the diagnostic accuracy. SETTINGS AND DESIGN: It is a retrospective review of prospectively collected data on 118 patients operated for suspected acute appendicitis in a single surgical unit between May 2001 and December 2002. METHODS AND MATERIAL: The detailed history, clinical examination and preoperative investigations according to protocol were recorded on a proforma. All patients underwent an ultrasonography of whole abdomen including pelvis. Each patient with suspected acute appendicitis was subjected to surgery and appendix was submitted for histopathological examination. The negative rate of appendicectomy, sensitivity and specificity of ultrasonography and positive and negative predictive value of ultrasound were calculated. RESULTS: The negative appendicectomy rate was 23.72%. In males it was 13.43% and in females 37.25%. Ultrasonography had a sensitivity of 63.33 % and a specificity of 82.14 %. The predictive value of a positive test was 91.93% and the predictive value of a negative test was 41.07%. CONCLUSIONS: The clinical diagnosis of acute appendicitis when supplemented with an ultrasonography, can achieve a reasonable degree of diagnostic accuracy with resultant low negative exploration rates thereby reducing the financial burden and morbidity by avoiding unnecessary appendicectomy and keeping the cost of treatment affordable.
CONTEXT: Acute appendicitis poses a significant diagnostic challenge to the surgeon. Despite modern advances, the diagnosis of appendicitis remains essentially clinical. Ultrasonography is effective in supplementing the clinical diagnosis. AIMS: This study aims to evaluate the negative appendicectomy rate in patients subjected to appendicectomy and to assess the usefulness of ultrasound in improving the diagnostic accuracy. SETTINGS AND DESIGN: It is a retrospective review of prospectively collected data on 118 patients operated for suspected acute appendicitis in a single surgical unit between May 2001 and December 2002. METHODS AND MATERIAL: The detailed history, clinical examination and preoperative investigations according to protocol were recorded on a proforma. All patients underwent an ultrasonography of whole abdomen including pelvis. Each patient with suspected acute appendicitis was subjected to surgery and appendix was submitted for histopathological examination. The negative rate of appendicectomy, sensitivity and specificity of ultrasonography and positive and negative predictive value of ultrasound were calculated. RESULTS: The negative appendicectomy rate was 23.72%. In males it was 13.43% and in females 37.25%. Ultrasonography had a sensitivity of 63.33 % and a specificity of 82.14 %. The predictive value of a positive test was 91.93% and the predictive value of a negative test was 41.07%. CONCLUSIONS: The clinical diagnosis of acute appendicitis when supplemented with an ultrasonography, can achieve a reasonable degree of diagnostic accuracy with resultant low negative exploration rates thereby reducing the financial burden and morbidity by avoiding unnecessary appendicectomy and keeping the cost of treatment affordable.
Authors: Andrea S Doria; Rahim Moineddin; Christian J Kellenberger; Monica Epelman; Joseph Beyene; Suzanne Schuh; Paul S Babyn; Paul T Dick Journal: Radiology Date: 2006-08-23 Impact factor: 11.105