Reliability of ultrasonography in the diagnosis of acute appendicitis

Authors

  • Thomas George Department of General Surgery, Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
  • Rajan Babu K.N. Department of General Surgery, Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
  • Thomas P. T. Department of General Surgery, Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India

DOI:

https://doi.org/10.18203/2349-2902.isj20151509

Keywords:

Ultrasonography, Appendicitis, Negative appendicectomy rate

Abstract

Background: Ultrasonography (US) is a commonly used investigation for diagnosing appendicitis. Although previous studies have shown US to be less sensitive than CT, proceeding with appendicectomy for all patients with positive US for appendicitis can save valuable time and cost. The aim of this study is to determine the value of a positive US for appendicitis and the outcome of operating on all these patients.

Methods: This is a retrospective analysis of a cohort of 200 consecutive patients who underwent appendicectomy due to a positive US diagnosis of appendicitis, between January 2014 and November 2015. Their histopathology reports were analysed to determine the number of patients with histological evidence of appendicitis.

Results: 179 out of the 200 patients showed a positive evidence of appendicitis on histology. This equates to a Positive Predictive Value (PPV) of 89.5% and a Negative Appendicectomy Rate (NAR) of 10.5% in these patients.

Conclusions: In our centre, we felt it was justified to operate on patients with a positive US for appendicitis due to a high PPV and low NAR. Furthermore, US have the added benefits of being less expensive, easy to do, repeatable and rapid to complete. Thus, we recommend that in centres such as ours where ultrasonography is available all the time, a positive US should be the first investigation of choice for deciding operative management. Patients with an equivocal US diagnosis should be monitored with further clinical assessment and CT scan.

References

Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am. J. Epidemiol. 1990;132:910–25.

Pittman-Waller VA, Myers J G, Stewart R M, Dent D L, Page C P, Gray GA et al. Appendicitis: Why so complicated? Analysis of 5755 consecutive appendectomies. Am Surg. 2000;66:548–54.

Vissers RJ, Lennarz WB. Pitfalls in appendicitis. Emerg Med Clin. North Am. 2010;28:103–18.

Reginelli A, Mandato Y, Solazzo A, Berritto D, Iacobellis F,Grassi R. Errors in the radiological evaluation of the alimentary tract: part II. Semin. Ultrasound CT MR. 2012;33:308–17.

Stabile IAA, Lorusso F, Niccoli AA, Di Maggio P, Fonio P, Losco M et al. Multidetector CT for the assessment of the groin region. Recenti Prog Med. 2012;103:483–8.

Hernanz-Schulman M. CT and US in the diagnosis of appendicitis: an argument for CT. Radiology 2010;255:3–7.

Papandria D, Goldstein SD, Rhee D, Salazar J H: Risk of perforation increases with delay in recognition and surgery for acute appendicitis. J Surg Res. 2013;184:723–9.

Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P et al. Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature. Crit Ultrasound J. 2013;5 (Suppl 1):1-3.

Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology. 1986;158: 355–60.

Webb EM, Nguyen A, Wang ZJ, Stengel JW, Westphalen AC, Coakley FV et al. The negative appendectomy rate: who benefits from preoperative CT? Am J Roentgenol. 2011;197:861–6.

Van Randen A, Bipat S, Zwinderman AH, Ubbink DT, Stoker J, Boermeester MA. Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology .2008;249(1):97-106.

Suen K, Hayes IP, Thomson BNJ, Shedda S. Effect of the introduction of an emergency general surgery service on outcomes from appendicectomy. Br J Surg. 2014;101:e141–6.

Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004;141: 537–46.

Pacharn P, Ying J, Linam LE, Brody AS, Babcock DS. Sonography in the evaluation of acute appendicitis: Are negative sonographic findings good enough? J Ultrasound Med.2010; 29:1749–55.

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Published

2016-12-13

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Original Research Articles