Study of modified Alvarado score and ultrasound imaging with post - operative histopathology in diagnosis of acute appendicitis

Abstract

Introduction: Acute appendicitis, though one of the commonest emergencies in surgical practice, can at times confuse the best of clinicians. Failure of an early diagnosis could lead to progression of the disease process with its attendant morbidity as well as occasional mortality. In spite of the technical advances, diagnosis of acute appendicitis remains a clinical entity. A negative appendectomy rate of 20% has been described in the surgical literature. The aim of the present study was to evaluate the diagnostic accuracy of appendicitis through a comparison of the modified Alvarado score (MAS) and the abdominal ultra-sonogram for diagnosing patients with suspected acute appendicitis.Patients and methods: An analytic and observational study was conducted on 50 patients during a period of 24 months, from October 2017 to September 2019. Patients that were initially suspected of presenting with acute appendicitis that were rule doubt before surgery were eliminated from the study and gynecological and urological diseases, pregnant females, any mass per abdomen and appendicular abscess and ruptured appendix diagnosed Intraoperatively were excluded from study. The variables analyzed were age, surgical result, and score results from the modified Alvarado score and preoperative Ultrasound findings. These were then compared with postoperative histopathology report.Results and discussion: During the study period total 50 patients included in this study, all the patients underwent classical appendicectomy. The mean age of patients is 32.84±6.35 and male to female ratio of 3:2 Correlating the patients’ modified Alvarado score (MAS) with the post-operative histopathological reports, the following observations were made. 5(10%) patients had a Modified Alvarado score of 1 – 4, out of which 3(60%) patients had histopathological evidence of reactive lymphoid hyperplasia and 2(40%) patients were found to be negative for appendicitis. None had a pathological evidence of acute appendicitis in either sex. In 15(30%) patients with MAS of 5-7, 8 (53.33%) patients had histopathological evidence of acute appendicitis; 6(40%) patients had reactive lymphoid hyperplasia and 1(6.66%) patient revealed unremarkable appendix on histopathology. Among the 30 (60%) patients with a modified Alvarado score of more than 7, 26(86.66%) had histopathological evidence of acute appendicitis; 3(10%) patients had reactive lymphoid hyperplasia and 1(3.33%) was unremarkable. All the patients were subjected to ultra-sonogram of the abdomen. Of the 50patients, 41 (82%) had USG findings suggestive of acute appendicitis. In 9 (18%) patients, the appendix did not reveal any features suggestive of acute appendicitis.Conclusion: To conclude acute appendicitis is a common surgical abdominal emergency. Modified Alvarado score is an on invasive, safe diagnostic procedure, which is simple, fast, reliable and repeatable. It can be used in all conditions, without expensive and complicated supportive diagnostic methods. Modified Alvarado score increases the diagnostic certainty of clinical examination in diagnosis of acute appendicitis.