Clinical Suspicion Of Acute Appendicitis Research Articles

WP1.17 - Double Trouble - A Case of Duplex Appendix

Abstract Introduction Duplex appendix, a rare anatomical anomaly is often encountered incidentally during appendicectomy procedures. It is characterised by the presence of two appendiceal lumens and can be classified using the Cave-Wallbridge classification system. Case An 18-year-old male presents to the Emergency Department with a two-day history of migratory right iliac fossa pain. He was consented and booked for a laparoscopic appendicectomy based on clinical suspicion of acute appendicitis. Intra-operatively, an unexpected finding surfaces—a second pendunculated mass adjacent to the inflamed appendix. Employing laparoscopic linear staples, both the appendix and the adjacent mass were divided. One day post-discharge, the patient presents with severe abdominal pain and computed tomography imaging suggests an intra-abdominal leak. The patient underwent an emergency laparotomy and ileo-caecal resection overnight. Histology revealed the second pedunculated mass was indeed a second appendix, a phenomenon with a reported incidence of 0.004 to 0.009%. Discussion Addressing the nuances of using imaging modalities in the diagnosis and operative planning of acute appendicitis, our discussion raises pertinent questions regarding the necessity of definitive pre-operative imaging in suspected cases. Considering potential pitfalls of incorrect clinical diagnoses; the presence of anatomical anomalies; and other factors influencing surgical decision-making; we scrutinise the proposition of pre-operative imaging protocols in suspected acute appendicitis. Conclusively our case encapsulates the diagnostic and therapeutic conundrums posed by duplex appendix instances, prompting a deeper exploration into the use of imaging techniques in a traditionally clinically diagnosed presentation and the implications thereof in surgical management.

Predictive values of indirect ultrasound signs for low risk of acute appendicitis in paediatric patients without visualisation of the appendix on ultrasound

Background and objectivesThe ability to rule appendicitis in or out using ultrasound is limited by studies where the appendix is not visualised. We determined whether the absence of indirect ultrasound...

EGS P36 Scan every clinical appendicitis before operation. Can we prevent unnecessary operations in this era of CT?

Abstract Background Acute appendicitis is the most common abdominal surgical emergency in the world, with around 50,000 acute appendectomies performed annually in the UK. However, appendectomy has been associated with negative appendectomy rates (NARs) of 15%-39% in large series. On the other hand, CT scan is associated with radiations increasing the risk of cancer and considerable cost to the trust. Methods Notes of 25 patients admitted with suspicion of acute appendicitis were reviewed retrospectively by the auditors from their admission to the discharge from hospital and CT scan reports were evaluated. Results All of the patients seen by the surgical team had a CT scan to confirm the diagnosis of acute appendicitis before surgery. 15/25 patients had a diagnosis of acute appendicitis and all of the histology reports in these patients after the surgery confirmed the diagnosis. 10/25 patients had other diagnosis on CT despite clinical features suggestive of acute appendicitis. Colitis was the second most common cause of abdominal pain after acute appendicitis. 0% negative appendectomy rate was achieved when CT scan was done before the surgery. Conclusions This audit concludes that all the patients who present with the clinical suspicion of acute appendicitis should have a CT scan before the surgery to avoid the unnecessary operations however, an audit of 1 year or more would be more beneficial in formulating a clear picture and the development of guidelines.

Unnoticed ingestion of magnetic balls mimics acute appendicitis

Magnetic object ingestion is rare; however, it is important to be considered and recognized by physicians. Its incidence is expected to be 3.06 cases per 100000 children per year but during the last decade this number has grown fivefold owing to the growing popularity of magnetic toys. Although a single FB may pass spontaneously and uneventfully through the digestive tract, the ingestion of multiple magnetic can cause serious morbidity due to proximate attraction through the intestinal wall. In everyday clinical practice, physicians combine their clinical suspicion of acute appendicitis (AA) with laboratory tests findings and imaging studies to make a final diagnosis. CT scan can be useful in some cases to avoid per operative surprise. We report a case of an 8 years -old child who his admitted for query acute appendicitis. Radiological investigation shows three magnets ball at the right iliac fossa with air fluid level without any signs of perforations. Taking up the clinical history, the patient seems reliable and does not remember having ingested these balls. Colonoscopy fails to remove all the magnets. At surgery we found two perforations one at the terminal ilium and the other on the lateral side of cecum with perforation of the mesoappendix and inflamed appendix. An appendectomy was done with primary closure of both perforations. • Discordance between the clinical suspicion of acute appendicitis with laboratory tests findings and ultrasound study must alert the physician. • Multiple magnets balls ingestion may lead to intestinal perforation with no evident clinical signs.

Diagnostic Accuracy of Fact in Clinically Suspected Cases of Acute Appendicitis in Adolescents and Adults, Taking Surgical Findings as Gold Standard

Objective: to evaluate the diagnostic accuracy of FACT in clinically suspected cases of Acute Appendicitis in adolescents and adults, taking surgical findings as gold standard. Methods: A total of 335 patients referred from emergency department with clinical suspicion of acute appendicitis were enrolled at Radiology Department, Services Hospital Lahore, from April, 2016 to October, 2016. FACT was performed using multi-slice CT. The cases underwent surgery and the results were recorded. The results of Focused Abdominal Computed Tomography and surgery were compared taking surgical findings as gold standard. Results: The mean age of patients in our study was 23.01 ± 5.479. We found 278 true-positives, 50 true-negatives, 04 false-negatives results, with sensitivity of 98.6%, a specificity of 94.3%, a PPV of 98.9%, a NPV of 92.6%, and an accuracy of 98%. An alternate diagnosis was made by FACT in 40 patients (11.9%). Conclusion: FACT (focused non-enhanced abdominal computed tomography) is a highly accurate imaging modality for diagnosis of acute appendicitis in adolescents and adults. Keywords: Focused Abdominal CT, Acute Appendicitis, FACT, Diagnostic Acuuracy

Pediatric Appendicitis Score for Identifying Acute Appendicitis in Children Presenting With Acute Abdominal Pain to the Emergency Department

To determine the diagnostic accuracy of Pediatric Appendicitis Score (PAS) in predicting appendicitis in children presenting with acute abdominal pain to the Emergency Department (ED) of a private hospital in Pakistan. This validation study was through retrospective chart review of children between 4-18 years of age with clinical suspicion of acute appendicitis, presenting to the pediatric ED. Diagnostic accuracy was determined using sensitivity, specificity, predictive values, and area under the curve (AUC). 104 children (76% boys) with mean (SD) age of 10.9 (3.5) years met the eligibility criteria. 91% (n=95) patients had moderate to high PAS (score ³4), and 95% (n=99) had biopsy-proven appendicitis. The likelihood ratio calculated for low, equivocal and high-risk PAS was 0.10, 2.17 and 2.53, respectively. An equivocal PAS (score 4-6) showed a sensitivity of 96.8%, specificity of 80%, positive predictive value of 98.9% and AUC of 0.84 for predicting acute appendicitis. PAS showed good diagnostic accuracy in predicting acute appendicitis in children presenting to the ED.

Red Blood Cell Distribution Width: Diagnostic Value in Pediatric Acute Appendicitis

Introduction and Objectives: Acute appendicitis (AA) is one of the most common causes of urgent surgery in children and is still associated with diagnostic difficulties. As the red blood width (RDW) and mean platelet volume (MVP) may be related to inflammatory processes, this study aims to evaluate the diagnostic value of RDW in AA in pediatric population. Methods: A retrospective and observational study was conducted. Data was collected from medical records of all patients with clinical suspicion of AA who underwent appendectomy at a secundary hospital during a period of 36 months. Preoperative analytical values were analyzed and compared with a control group. Results: Medical records of 305 patients with a mean age of 12.1 years were analyzed. Children with simple or perforated appendicitis had significantly higher RDW than those with a normal appendix. Compared with the controls mean RDW was significantly higher in the acute appendicitis group (14.16 ± 1.2% vs.13.09 ± 0.9%, p <0.05). No statistically significant differences were found in the analytical parameter VPM in the diagnosis of AA. Conclusion: In this study, children with an histologically diagnosed acute appendicitis have higher RDW than children without appendicitis. Being a parameter included in the blood count and without additional costs, it may represent a valuable aid in the diagnosis of acute appendicitis in children. Further research is needed due to the limited number of studies on this topic in childhood.

MRI as First Line Imaging for Suspected Acute Appendicitis during Pregnancy: Diagnostic Accuracy and level of Inter-Radiologist Agreement

ObjectiveEvaluation of acute appendicitis (AA) in pregnancy is supported with diagnostic imaging. Typically, ultrasound (US) is performed first, and then often followed by magnetic resonance imaging (MRI) due to continued diagnostic uncertainty. The purpose of our study was to evaluate the sensitivity, specificity, and accuracy of US as compared to MRI and to evaluate the inter-radiologist agreement amongst body Radiologists with varying levels of expertise. Materials and MethodsWe performed a retrospective study of 364 consecutive pregnant patients with clinical suspicion of AA at a single center over a 6-year period. Sensitivity, Specificity, accuracy, positive and negative predictive values were calculated for US and MRI. Inter Radiologist agreement was determined using Cohen's Kappa analysis between original interpreting Radiologist and retrospective review by expert Radiologist. ResultsThirty-one of 364 patients (8.5%) underwent appendectomy based on preoperative diagnosis, with confirmation of acute appendicitis (AA) by pathology in 19. US was able to visualize the appendix in only 6 (1.65%), 5 of whom had appendicitis. 141 patients underwent MRI, and correctly diagnosed appendicitis in 9. No patient with a negative MRI diagnosis had AA. The sensitivity, and negative predictive value for diagnosing AA with MRI was 100%. The MRI inter-reader agreement for appendix visualization and overall accuracy were 87.9 and 98% with Cohen Kappa of 0.7 and 0.56 respectively. ConclusionsOur data suggests that MRI should be considered the first line imaging modality in pregnant patients suspected of having AA. Body Radiologists with varied levels of experience in MRI readouts had substantial agreement.

236 Omental Fat Torsion Masquerading Clinically as Acute Appendicitis in a Young Male Patient: A Rare Aetiology of Acute Abdomen and The Value of Diagnostic Laparoscopy

Abstract Acute abdominal pain is a common surgical presentation and acute appendicitis remains the top differential for most young adults. Omental fat torsion has emerged as a rare aetiology of an acute surgical abdomen in the younger population that closely mimics acute appendicitis in its clinical presentation. Preoperative diagnosis is extremely challenging in this age group due to the rarity of the condition and the non-specific nature of its clinical and laboratory findings, and hence most reported diagnoses were made intra-operatively. We report a case of omental fat torsion in a 22-year-old male who presented with clinical features that were highly suggestive of acute appendicitis. However, the diagnostic laparoscopy revealed a normally looking appendix and terminal ileum, with the presence of a twisted segment of the greater omentum in the right lumbar region. A laparoscopic omentectomy and a prophylactic appendectomy to prevent furture acute appendicitis were performed with an uneventful postoperative recovery. Histology confirmed omental fat infarction and a normal appendix. This reported case highlights a rare cause of right iliac fossa pain and demonstrates the value of diagnostic laparoscopy in the context of clinically suspected acute appendicitis in younger male patients. Diagnostic imaging was not deemed necessary in our patient given the strong clinical suspicion of acute appendicitis. Prompt laparoscopy led to definitive diagnosis as well as treatment and avoided the radiation exposure necessitated during a diagnostic computed tomography scan.

Acute Appendicitis in Children

Objectives: This study was planned to show the mode of presentation of children under six years of age with acute appendicitis and to increase the awareness of general, pediatric surgeons and other health care professionals about the magnitude of the problem so that to improve diagnostic accuracy and to avoid detrimental effects of delay in diagnosis and effective surgical management. Patients and Methods: The study included (67) children with clinical suspicion of acute appendicitis admitted to emergency department of Kirkuk General Hospital from January 2008 - June 2012. Their age ranged (3 – 6) years (Mean age 4.5 years). (39) Males and (28) females. (M: F was 1.4:1). All had appendectomy as an emergency setting. The presentation, diagnostic work up and operative findings were studied. Results: The main presenting symptom was abdominal pain 62(92%) followed by vomiting which was seen in 53(77%) of our patients. Other symptoms were change in bowel motions, anorexia, abdominal distension and fever. The most common physical sign elicited was localized tenderness at right lower quadrant 64(95%) while guarding was present in nearly half of our patients 36(53%). (41) Children had urgent appendectomy as diagnosis of acute appendicitis was clear and in the remainder (26) children a period of active observation and serial examinations with completion of diagnostic work up were needed before surgical intervention. Conclusion: Acute Appendicitis in preschool children under six years of age needs special consideration. About one third of them have atypical presentation, physical signs are difficult to be elicited. A period of active observation in needed in most of them to complete diagnostic work up. Every effort should be directed towards improving the diagnostic accuracy and performance of effective surgical management to reduce morbidity and mortality and to decrease negative appendectomy rate and to avoid risks of unnecessary surgery

C-reactive protein, as a marker for predicting acute appendicitis and its severity in KVG medical college and hospital, Sullia

Background: Appendicectomy for suspected acute appendicitis is a common procedure. The rate of normal appendices unnecessarily removed remains high despite several techniques and investigations used to improve the diagnostic accuracy. This study emphasizes the value of C reactive protein (CRP) in three groups of patients operated for clinical suspicion of acute appendicitis with different finding at appendicectomy namely an un-inflamed appendix, uncomplicated acute appendicitis or complicated acute appendicitis.Methods: This prospective study was performed on 100 consecutive patients who were operated on for treatment of acute appendicitis in KVG medical college and hospital between 01 August 2019 to 01 February 2021. Clinically proven by a surgeon, patients underwent appendicectomy. Serum CRP results of all patients were determined. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Statistical analysis will be made using descriptive statistic and SPSS version 21 was used for analysis.Results: The percentage of negative laparotomies was 13% and surgeon ‘s clinical suspicion was true in 87%. Preoperative CRP values were false negative in 21 patients with appendicitis and false positive in 2 patients with normal appendix. The difference of true and false results between CRP tests and surgeon’s diagnosis was statistically significant (p=0.001). Present study revealed, sensitivity=76%, specificity=87.5%, positive predictive value=96% and negative predictive value=41%.Conclusions: Serum C reactive protein when elevated supports the surgeon’s clinical diagnosis of acute appendicitis. It can be used frequently to diagnosis the acute appendicitis, so that the complication rate and negative laparotomies can be avoided.

Study of the combination of Alvarado score and Ultrasonography in diagnosing acute appendicitis

Acute appendicitis is a common surgical emergency with a lifetime risk of about 6 - 7%. Appendicectomy is the treatment of choice. A delay in the diagnosis and management can lead to complications such as appendicular rupture, abscess and peritonitis. In the current era of evidence based medicine, negative appendicectomies are not acceptable. The Alvarado score is in use since a long time for the diagnosis of acute appendicitis. Ultrasound is the first line investigation used in case of suspected acute appendicitis. Various studies have shown that Alvarado score or Ultrasonography individually, is insufficient diagnostic tools. Some studies have shown that their diagnostic efficacy is increased when used in combination with one another. This prospective comparative study carried out in 100 patients with a clinical suspicion of acute appendicitis proves that the combination of Alvarado score and Ultrasonography is a better diagnostic tool, compared to either of the two, alone.

Asociación entre el diámetro apendicular tomográfico y el diagnóstico anatomopatológico de apendicitis aguda en el Hospital Militar Central entre 2015-2019

Objetivo: identificar la asociación entre el diámetro apendicular tomográfico y el diagnóstico anatomopatológico en pacientes con sospecha clínica de apendicitis aguda del Hospital Militar Central entre 2015 y 2019; y determinar la validez diagnóstica de dicho signo tomográfico. Materiales y métodos: se realizó un estudio analítico de corte transversal. La muestra obtenida fue de 104 pacientes post apendicectomizados del Hospital Militar Central desde 2015 a 2019, que contaron con informe tomográfico por sospecha clínica de apendicitis aguda y análisis anatomopatológico de la pieza operatoria. Se reportaron frecuencias absolutas y porcentajes de las variables de estudio, seguido de un análisis bivariado mediante la prueba exacta de Fisher. Asimismo, se estimaron razones de prevalencia (RP) mediante una regresión de Poisson para los criterios tomográficos y se realizaron los cálculos de pruebas de validez diagnóstica de cada criterio tomográfico. Resultados: de 104 pacientes, el 35% tuvo de 18 a 30 años, el 69% fueron de sexo masculino; 86 pacientes fueron confirmados por anatomopatología; de los cuales, 70 pacientes presentaron diámetro apendicular ≥ 6 mm. Se observó que el diámetro apendicular, el grosor de la pared, la alteración de la grasa periapendicular y el líquido libre tuvieron diferencias estadísticamente significativas en relación al resultado anatomopatológico. Además, el diámetro apendicular tuvo una sensibilidad de 81,4%, especificidad de 55,5%, valor predictivo positivo de 89,7% y valor predictivo negativo de 38,4%. Conclusiones: un diámetro apendicular ≥ 6 mm se asocia a una probabilidad de 1,45 veces de que el resultado anatomopatológico sea positivo en pacientes con sospecha clínica de apendicitis aguda.

Parakolik lenf nodu: Pediyatrik perfore apandisitte yeni bir tanı belirteci olabilir mi?

Objective: Acute appendicitis is the most common reason for emergency abdominal surgery in pediatric population. Ultrasonography (US) is a widely used modality to diagnose acute appendicitis. Despite its success in diagnosing acute appendicitis, US have been reported to have a poor diagnostic accuracy to detect perforated appendicitis. We have frequently encountered lymph nodes around transvers colon in pediatric perforated appendicitis cases. We mainly aim to evaluate the accuracy of paracolic lymph node presence as a new diagnostic marker for perforated appendicitis. Materials and Methods: We have evaluated the US reports and/or images of the patients referred to radiology department with a clinical suspicion of acute appendicitis. Paracolic lymph node presence and sonographic findings indicating perforated appendicitis were recorded. Patients were divided into three subgroups according to their final diagnosis: Acute appendicitis, perforated appendicitis, others. Results: Mean age of the population was 14.9±2.3 years. There were 300 acute appendicitis cases, 71 perforated appendicitis cases, and 92 other diagnosis cases (4 lymphoid hyperplasia, 88 normal appendix). Rates of lymph node presence in paracolic area were 41/300 (13.6%) in acute appendicitis subgroup, 58/71 (81.6%) in perforated appendicitis subgroup, and 4/92 (4.34%) in other diagnosis subgroup. A longest diameter of a paracolic lymph node > 8.5 mm seemed to be a good predictor for perforated appendicitis diagnosis (sensitivity 85%, specificity 77%). Conclusion: we showed a statistically significant association between paracolic lymph node presence and perforated appendicitis. This sign can serve to confirm perforated appendicitis diagnosis over simple appendicitis.

A comparative study on the diagnostic validity of three scoring systems in the diagnosis of acute appendicitis in emergency centres

BackgroundConsidering the inconsistencies on the validity scoring systems in the diagnosis of acute appendicitis, our aim was to compare the accuracy of the three Anderson, Alvarado and Alvarado + CRP scoring systems in the diagnosis of patients with suspected acute appendicitis.MethodsThis was a prospective observational study performed on patients 15–65 years complained of abdominal pain in the RLQ with a high clinical suspicion of acute appendicitis within two years. The scoring systems of Anderson, Alvarado, and Alvarado + CRP were recorded using a pre-prepared questionnaire by a senior emergency medicine assistant. Acute appendicitis was confirmed based on the histopathologic findings. Written informed consent was obtained from all the patients before entering the study.Results200 patients were enrolled in the study. In 159 cases diagnosed with appendicitis based on histopathological findings, Anderson, Alvarado, and Alvarado scoring systems were able to identify 121, 152, and 147 cases respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 77%, 19%, 78%, 17 and 64% in Anderson, 95%, 7%, 75%, 30% and 77% in Alvarado, and 92%, 7%, 79%, 20%, and 75% in Alvarado + CRP scoring systems, respectively.ConclusionAnderson scoring system had lower diagnostic accuracy than the Alvarado system. The role of CRP as an adjunct test to increase the accuracy of the Alvarado scoring system in the diagnosis of acute appendicitis has been under question. Given the inconsistent results of the scoring systems in the diagnosis of acute appendicitis, there is a need to develop a more precise clinical-paraclinical scoring system for this condition.

Reducing the negative appendectomy rate with the laparoscopic appendicitis score; a multicenter prospective cohort and validation study.

Approximately nine percent of all acute appendectomies are unintentionally performed on a normal appendix. Failure of treatment (negative appendectomy or missed appendicitis) is associated with higher morbidity and mortality when compared to appendectomy for uncomplicated appendicitis. The Laparoscopic APPendicitis (LAPP) score was developed in order to systematically evaluate the appendix for the presence of inflammation. This study aims to determine whether the LAPP score reduces the negative appendectomy rate without missing appendicitis. From September 2013 through May 2016, 322 adult patients presenting with a clinical suspicion of acute appendicitis and an indication for diagnostic laparoscopy were included and analyzed in this multicenter prospective validation study. Depending on the LAPP score, the appendix was either removed (n=300) or left in situ (n=22). These patients were compared to a historical control group of 584 patients treated at the same hospitals. The appendix was examined by a pathologist and the negative appendectomy rate was calculated. The negative appendectomy rate was significantly lower when the LAPP score was used (4,7% vs. 8,4%; P=0,034). None of the patients with a negative LAPP score, in which the appendix remained in situ, developed acute appendicitis within three months. There were no significant differences in operation time, complications, or readmissions. Using the LAPP score was associated with significantly higher rates of preoperative radiological imaging (98% vs. 70%; P< 0,001). After adjusting for covariables, including radiological imaging, use of the LAPP score led to fewer treatment failures when compared to not using the LAPP score (OR: 0,48, 95% C.I. 0,251 to 0,914; P=0,025). The LAPP score is a safe and simple tool to reduce the negative appendectomy rate during laparoscopic surgery without missing cases of acute appendicitis.

Short-term outcome of Laparoscopic Appendicectomy and Open Appendicectomy in acute appendicitis- a comparative study

Background: Appendectomy, though being performed by both open and laparoscopic methods, there is a lack of consensus regarding which is the most appropriate method. This study will document important variables and parameters to compare therapeutic benefit of laparoscopic Appendectomy (LA) and open Appendectomy (OA). Objective: The study aimed at comparing the short- term outcome of laparoscopic Appendectomy and open appendectomy in cases of acute appendicitis, in terms of postoperative pain and complications, hospital stay, recovery and return to normal activities.&#x0D; Methods: Whenever there was clinical suspicion of acute appendicitis, the patient was admitted to hospital, relevant history was recorded and clinical examination was conducted, necessary laboratory and imaging studies were performed and patient satisfying the inclusion and exclusion criteria was included in the study. The Appendectomy procedure was attended by the investigator and all relevant perioperative data were recorded.&#x0D; Results: Post-operative pain was mostly mild in LA group (40%), while in OA, it was mostly severe (38%) and moderate (34%). Postoperative complications were significantly higher in OA than in LA. Hospital stay was longer in OA (7.03 days) than LA (3.49 days). Early recovery and return to full normal activity was noted in LA (5.56 days) than in OA (11.26 days). Moreover, operative time was shorter in LA (56.37 min), than in OA (71.86 min).&#x0D; Conclusion: Laparoscopic Appendectomy have clear advantages over open Appendectomy in respect to short term results.&#x0D; Journal of Surgical Sciences (2017) Vol. 21 (2): 70-75

Usefulness of the Pediatric Appendicitis Score and Neutrophil to Lymphocyte Ratio for Assessing the Complicated Appendicitis in Children

Introduction: Acute appendicitis (AA) is a common surgical disease which occurs in almost all age groups, and especially in childhood. Acute appendicitis is one of the most common causes of acute abdomen. The lifetime occurrence of this disease is approximately 7%, with perforation rate of up to 20%. In spite of the well-known classical symptoms and clinical findings of acute appendicitis, early diagnosis can be sometimes challenging. For the treatment of simple appendicitis (SA) in children, the effectiveness of antibiotic treatment has been reported. We aimed to determine predictive value of combination NLR and PAS in pediatric patients with clinical suspicion of acute appendicitis and complicated appendicitis Methods: Our study was performed on 480 children admitted for suspected acute appendicitis and underwent appendectomy at the MNCMCH, Ulaanbaatar Mongolia, between May 2019 and December 2019. White blood count (WBC), Neutrophil, NLR and PAS were compared between groups. Results: The sensitivity, specificity, PPV, NPV of PAS + NLR for differentiating complicated and noncomplicated appendicitis were 86.8%, 89.4%, 92.1% and 76% respectively. The sensitivity, specificity, PPV, NPV of PAS + NLR for diagnosis of acute appendicitis were 90.5%, 68.1%, 97.68% and 32.6% respectively. Conclusion: In the era of conservative antibiotic-based management of uncomplicated acute appendicitis, we advocate that combination of NLR and PAS is a useful aid in predicting complicated appendicitis.

Comparison of diagnostic scoring systems with imaging methods for the diagnosis of acute appendicitis

Aim: Acute appendicitis scores have been developed to better analyze the symptoms and signs of acute appendicitis. In this study, we compared the success rates of different scoring systems with imaging methods in the diagnostic confirmation of acute appendicitis.Materials and Methods: Patients aged above 18 years, who presented to the emergency department with right lower quadrant pain and were suspected to have acute appendicitis, were prospectively and observationally evaluated. The demographic characteristics, imaging modalities, Alvarado score, acute inflammatory response score, and adult appendicitis score were assessed.Results: 237 patients, 46.8% female and 53.2% male, mean age of 34±13 (18-95) years. Appendectomy was performed in 144 (61%) patients with a prediagnosis of acute appendicitis. The pathological results were appendiceal cancer in two patients, lymphoid hyperplasia in 12, and acute appendicitis in 130. Imaging methods were found to be more specific than scores, and positive predictive values in scoring systems were more sensitive than imaging methods in the diagnosis of acute appendicitis.Conclusion: There is still no effective and guiding scoring system for the diagnosis of acute appendicitis. Due to the low negative predictive values of the available scoring systems, patients should be evaluated with detailed anamnesis, examination and laboratory findings, and computed tomography should be performed if there is clinical suspicion of acute appendicitis.

Diagnostic yield of abdominal ultrasonography for the diagnosis of acute appendicitis: A global and subgroup analysis.

Abdominal ultrasonography is very useful for diagnosing acute appendicitis and has 59-96% sensitivity and 83-98% specificity. The aim of the present study was to determine the diagnostic yield of abdominal ultrasound imaging for acute appendicitis and identify the patient subgroups with the best results. Patients at a general hospital that underwent appendectomy due to the clinical suspicion of appendicitis, who also had a diagnostic radiologic study, within the time frame of January 2007 to December 2010, were analyzed. Ultrasound studies were considered positive when there were radiologic signs suggestive of acute appendicitis. The sensitivity, specificity, and predictive values of the diagnostic study were determined through the logistic regression method. A total of 646 patients were operated on due to clinical suspicion of acute appendicitis. A diagnostic abdominal ultrasound study was carried out on 383 (59.3%) of those patients, resulting in 79% sensitivity (74-83, 95% CI), 58% specificity (39-75, 95% CI), 95% positive predictive value (92-97, 95% CI), and 20% negative predictive value (13-30, 95% CI). Abdominal ultrasound imaging in patients with a high suspicion of appendicitis had a mediocre diagnostic yield, but better results could be achieved in different specific subgroups.