Abstract
BackgroundThe present study aimed to address the importance of a new radiological sign - the presence of fecal loading at the caecum - for the diagnosis of acute appendicitis.MethodologyA cross-sectional study was conducted at the Department of General Surgery, Jinnah Postgraduate Medical Centre, Karachi from January 2020 to June 2020. Patients who presented in the emergency with acute pain at the right iliac fossa fulfilling the criteria of acute appendicitis (AA) according to the Alvarado scoring system, and were planned for appendectomy were included. Before surgery plain abdominal radiographs were taken in anteroposterior view in the supine position and were evaluated for the presence of fecal loading at the caecum. After that all patients underwent surgery and radiologic findings were correlated with histopathologic findings.ResultsThe mean age of patients was 32.19±7.34 years. There were 83 (55.3%) male and 67 (44.7%) female patients. Out of 150, there were 144 (96.0%) patients in whom fecal loading in the caecum was diagnosed on plain radiographs. On histopathology reporting, acute appendicitis was diagnosed in 143 (95.3%) patients. Regarding accuracy, fecal loading at the caecum was found to have a sensitivity of 98.6%, specificity of 83.3%, a positive predictive value of 99.3%, and a negative predictive value of 71.4%. ConclusionAccording to the results of the present study and existing literature, we suggest using fecal loading at the caecum along with a clinical scoring system for the diagnosis of acute appendicitis. As per our findings, fecal loading at the caecum is a valuable sign on plain abdominal radiograph for the diagnosis of AA. It has a sensitivity of 98.6% and a specificity of 83.3%. This sign typically becomes undetectable after an appendectomy. It will help to improve the accuracy of diagnosis of acute appendicitis, and hence will reduce the chances of negative appendectomy.
Highlights
Acute abdomen is a common emergency accounting for 7 to 10% of all emergency department admissions [1]
According to the results of the present study and existing literature, we suggest using fecal loading at the caecum along with a clinical scoring system for the diagnosis of acute appendicitis
Fecal loading at the caecum is a valuable sign on plain abdominal radiograph for the diagnosis of acute appendicitis (AA). It has a sensitivity of 98.6% and a specificity of 83.3%. This sign typically becomes undetectable after an appendectomy
Summary
Acute abdomen is a common emergency accounting for 7 to 10% of all emergency department admissions [1]. Acute appendicitis is the commonest cause of acute abdomen and is one of the most frequent diagnoses in young people visiting emergency departments [2]. The incidence of acute appendicitis has been declining since the 1940s in the modern world. The reported incidence from the developed world is 5.7 to 50 patients/100,000 population/year, while age 10 years to 30 years is reported to peak age of developing acute appendicitis [3,4]. Acute appendicitis incidence is affected by seasonal variations, incidence in Pakistan is higher in the summer season as compared to the winter season [6].
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