Assessment of the accuracy of using the combination of modified alvarado score and abdominal ultrasound in acute appendicitis

Abstract

Background: Appendix is a worm shaped blind tube of varying length (2-25) cm opening into the caecum 2cm below the ileocaecal valve in posteromedial valve. It is the only organ in the body that has no constant position. Incidence of acute appendicitis parallels that of lymphoid development with peak incidence in early adulthood. It is rare before the age of two. Before puberty the incidence of acute appendicitis is equal in both sexes. But after puberty there is a slight male preponderance. The objective of this study was to evaluate assessment of accuracy of the combined use of modified Alvarado scoring system and ultrasound in the diagnosis of acute appendicitis.Methods: Around 136 patient’s acute appendicitis were subjected to estimation of total leucocyte count and plain x-ray abdomen after thorough history evaluation and clinical examination before surgery. Alvarado score was found in all cases. All of them were operated on the day of admission itself and preoperative findings were noted. All appendicectomy specimens were subjected to histopathological examination (HPE).Results: Acute appendicitis is the most common surgical abdominal emergency in our hospital. Acute appendicitis is more common in males and the commonest age group affected is 21 - 30 years. Right iliac fossa pain is the most common presenting symptom followed by nausea/vomiting. In diagnosis of acute appendicitis Alvarado score has a high diagnostic value (82.5%).Conclusions: The combined use of modified Alvarado score with ultrasonogram done in patients with equivocal or low Alvarado score is useful in identifying the missed-out cases thereby preventing diagnostic delay and its attendant complications. Appendices that appear to be normal on macroscopic inspection may show features of acute appendicitis on histopathologic examination.