Abstract
Acute appendicitis it a quite common abdominal disorder and considered as a difficult diagnosis. An accurate diagnosis is essential to prevent any complication from delayed surgical intervention. Aim: To evaluate the diagnostic accuracy of ultrasound in acute appendicitis cases in Saudi Arabia compared with histopathology. Moreover, to determine whether there is a correlation between the accuracy of ultrasound in acute appendicitis and the sonographers’ expertise. Methods: A retrospective study was conducted, including patients who admitted to the emergency room with clinical symptoms of suspected acute appendicitis and underwent ultrasound examinations. Diagnostic features, including diameter of the appendix ≥7 mm, free fluid, lack of compressibility, no appendix seen, normal appearance, and thick wall, were recorded for each patient. Results: Only 61 of the 132 patients in the study were accurately diagnosed with the use of ultrasound. Just 44 of them were diagnosed with appendicitis (true positives) and 17 without appendicitis (true negatives). However, 69 patients who had positive histopathologic results received a negative ultrasound diagnosis (false negatives), and 2 patients with negative histopathologic findings had a positive ultrasound diagnosis (false positives). There was no significant association between the accuracy of the ultrasound diagnosis and the years of experience of the sonographers. Conclusion: a low level of diagnostic accuracy was demonstrated when utilizing ultrasound to diagnose cases of acute appendicitis. In addition, no association was found between the years of experience of the sonographer conducting the examination and the diagnosis of acute appendicitis.
Highlights
The histopathological results for each subject were retrieved from their medical records
The histopathology test was performed after they had surgery
This study demonstrated that US had low sensitivity, high specificity, high positive predictive values (PPV), and low negative predictive values (NPV), which is consistent with the majority of earlier studies [24,31,32,33]
Summary
Acute appendicitis it a quite common abdominal disorder with a lifetime incidence of 7% [1]. Based on clinical and laboratory data, acute appendicitis is considered as a difficult diagnosis and can mimic various medical conditions of urologic, gastrointestinal, or gynecologic origin [2,3]. Misdiagnosis and unneeded laparotomy may lead to sever complications and have detrimental consequences on fetal outcome [4]. The degree of inflammation can lead to inconsistent clinical presentation. It has been reported that the perforation risk in acute appendicitis can increase by 5% every 12 h, meaning that an appendectomy should be performed no later than 36 h after a diagnosis of acute appendicitis is confirmed [5]. Any delay in diagnosis can lead to adverse
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