Diagnosis Of Acute Appendicitis Research Articles

Appendicular ‘Googlies’ – Googlies bowled at us by the human vermiform appendix and mimickers of it’s acute inflammation ! – A Case series with Review of literature

Objective: Acute appendicitis is one of the common abdominal emergencies encountered in surgical practice. However there are a host of other medical and surgical conditions that closely mimic it, clinically. The objective of this paper is to present a study and analysis of our burden of incidental encounters with such mimicking surgical conditions that were erroneously diagnosed as acute appendicitis, prior to surgery. Methods: Data was retrieved from the hospital’s electronic medical records about all patients operated for acute appendicitis, by a single surgeon, over a 14 year period. Results: A total of 450 patients were operated for acute appendicitis from 2008 to 2022. Out of these, we identified 20 patients who had a normal appendix with some other mimicking surgical condition (Incidence 4.44%). Conclusion: Acute appendicitis has many differential diagnoses, both common and rare. At times, some of these are confirmed ‘on table’; as seen in this case series. A sound, reliable and fool proof palpatory assessment of the abdomen is crucial in diagnosing it’s surgical conditions. It is interesting to note that although the initial diagnosis of acute appendicitis made for all the subjects of this case series was erroneous, all still turned out to have alternate conditions which merited surgery.

Predictive Factors of Acute Appendicitis in Children With Non-Visualized Appendix on Ultrasound: A Prospective Cohort Study.

Background: Most studies have demonstrated the high accuracy of ultrasound for the diagnosis of acute appendicitis (AA) in children. However, the lack of visualization of the appendix on ultrasound is usually a challenge. The aim of this study was to identify any factors that might help the physician make the right decision when dealing with a child with suspected appendicitis and an appendix not seen on ultrasound. Patients and Methods: After receiving Institutional Review Board approval, we conducted a prospective study in a pediatric emergency department from January 1, 2022, to December 31, 2022. All children under 14 years of age with suspected AA and an appendix not visualized on ultrasound were included. Results: During the study period, 333 children presented with suspected AA. Of these patients, 106 had an appendix not seen on ultrasound. Our patients' median age was 10 years (interquartile range [IQR], 8-11 years), with 54.7% (n = 58) of children being female. Twenty-five (23.6%) were ultimately diagnosed with AA based on pathologic examination. Multivariable logistic regression analysis revealed that Alvarado score ≥6 and increased peri-appendiceal fat echogenicity were predictive for AA. The combination of these two factors provided a positive predictive value of 100%. A white blood cell (WBC) count ≤10 × 109/L and/or a C-reactive protein (CRP) level ≤6 mg/L makes the diagnosis of appendicitis unlikely. Conclusions: In conclusion, our study demonstrated that an Alvarado score at or above six and increased peri-appendiceal fat echogenicity are independent predictive factors of AA in children with non-visualized appendix on ultrasound. The combination of these two factors would confirm the diagnosis of AA in these patients.

Apendiks mukoselini akut apandisitten ayırmada klinik, radyolojik ve laboratuvar belirteçlerin rolü

ABSTRACT AIM: This study aims to assist the surgical treatment plan by increasing the rate of correct preoperative diagnoses through comparing the clinical, radiological, and laboratory findings of appendiceal mucocele (AM) and acute appendicitis (AA) before surgery. MATERIALS AND METHODS: The study included 63 patients with a histopathologic diagnosis of AM and AA among 4867 patients who underwent appendectomy with the diagnosis of acute appendicitis in the general surgery clinic between 2009 and 2020. The patients were separated into two groups: those with AM (21 patients) and those with AA (42 patients). Age, gender, physical examination (PE), Alvarado appendicitis score, ultrasonography (USG), computed tomography (CT), laboratory, preoperative diagnosis, intraoperative diagnosis, and pathological diagnosis results of both groups were compared. RESULTS: PE, abdominal pain, nausea, vomiting, fever symptoms, and Alvarado score were found to be significant between the two groups (p<0.05). In addition, WBC, NE, LYM %, and CRP were found to be high in group 2 (p<0.05), while there was no difference in radiological diagnosis (USG/CT) between the two groups (p<0.05). However, the appendix diameter was larger in group 1 (p<0.05). Patients with AM in 80% preoperatively, and 52% intraoperatively were operated on with a provisional diagnosis of AA. The second surgery was performed in Group 1 with a rate of 9.5% (2/21). CONCLUSION: In our study, patients with AM who underwent surgery with a diagnosis of AA were found to differ in radiological, clinical, and laboratory findings from patients with AA. KEYWORDS: Appendiceal Mucocele, Acute Appendicitis, Differential Diagnosis

Tryptase in Acute Appendicitis: Unveiling Allergic Connections through Compelling Evidence.

The aetiology of acute appendicitis (AA), the most frequent abdominal surgical emergency, is still unclarified. Recent epidemiologic, clinical and laboratorial data point to an allergic component in the pathophysiology of AA. Mastocytes participate in the Th2 immune response, releasing inflammatory mediators from their granules upon stimulation by IgE-specific antigens. Among the well-known mediators are histamine, serotonin and tryptase, which are responsible for the clinical manifestations of allergies. We conducted a prospective single-centre study to measure histamine and serotonin (commercial ELISA kit) and tryptase (ImmunoCAP System) concentrations in appendicular lavage fluid (ALF) and serum. Consecutive patients presenting to the emergency department with a clinical diagnosis of AA were enrolled: 22 patients with phlegmonous AA and 24 with gangrenous AA The control group was composed of 14 patients referred for colectomy for colon malignancy. Appendectomy was performed during colectomy. Tryptase levels were strikingly different between histological groups, both in ALF and serum (p < 0.001); ALF levels were higher than serum levels. Tryptase concentrations in ALF were 109 times higher in phlegmonous AA (APA) (796.8 (194.1-980.5) pg/mL) and 114 times higher in gangrenous AA (AGA) (837.4 (272.6-1075.1) pg/mL) than in the control group (7.3 (4.5-10.3) pg/mL. For the diagnosis of AA, the discriminative power of serum tryptase concentration was good (AUC = 0.825), but discriminative power was weak (AUC = 0.559) for the differential diagnosis between APA and AGA. Mastocytes are involved in AA during clinical presentations of both phlegmonous and gangrenous appendicitis, and no significant differences in concentration were found. No differences were found in serum and ALF concentrations of histamine and serotonin between histological groups. Due to their short half-lives, these might have elapsed by the time the samples were collected. In future research, these determinations should be made immediately after appendectomy. Our findings confirm the hypersensitivity type I reaction as an event occurring in the pathogenesis of AA: tryptase levels in ALF and serum were higher among patients with AA when compared to the control group, which is in line with a Th2 immune response and supports the concept of the presence of an allergic reaction in the pathogenesis of acute appendicitis. Our results, if confirmed, may have clinical implications for the treatment of AA.

Added value of ratio of cross diameters of the appendix in ultrasound diagnosis of acute appendicitis.

The maximum outer diameter (MOD) of the appendix is an essential parameter for diagnosing acute appendicitis, but there is space for improvement in ultrasound (US) diagnostic performance. To investigate whether combining the ratio of the cross diameters (RATIO) of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis. A retrospective study was conducted, and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed. The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis, both individually and in combination. The RATIO for a normal appendix was 1.32 ± 0.16, while for acute appendicitis it was 1.09 ± 0.07. The cut-off value for RATIO was determined to be ≤ 1.18. The area under the receiver operating characteristic curve (AUC) for diagnosing acute appendicitis using RATIO ≤ 1.18 and MOD > 6 mm was 0.870 and 0.652, respectively. There was a significant difference in AUC between RATIO ≤ 1.18 and MOD > 6 mm (P < 0.0001). When comparing the combination of RATIO ≤ 1.18 and MOD > 6 mm with MOD > 6 mm alone, the combination showed increased specificity, positive predictive value (PPV), and AUC. However, the sensitivity and negative predictive value decreased. Combining RATIO of the appendix ≤ 1.18 and MOD > 6 mm can significantly improve the specificity, PPV, and AUC in the US diagnosis of acute appendicitis.

Diagnostic performance of spectral Doppler in acute appendicitis with an equivocal Alvarado score.

This study aims to evaluate the added value of duplex Doppler examination to the routinely graded compression grayscale ultrasound (US) for patients with suspected acute appendicitis (AA) in correlation with surgical management outcomes. The study lasted from January 2020 to March 2021. Throughout that period, patients who had suspected appendicitis were included with a visible appendix in the grayscale US. These patients were categorized clinically based on Alvarado's score. They underwent graded compression grayscale US of the appendix and duplex Doppler study. Subsequently, they were assigned for non-contrast multislice computed tomography (MSCT) according to Alvarado's score and underwent either emergency appendicectomy or conservative clinical management afterward. A Student's t-test was used to determine if there were significant differences in the mean values between the groups. The diagnostic performance of spectral Doppler US for the diagnosis of AA was depicted. Eighty-four patients with visualized color flow in the appendicular Doppler US were enrolled, with 60 (71.4%) having AA, and 24 (28.6%) not having appendicitis. Spectral Doppler criterion of PSV greater than 8.6 cm/s demonstrated a high sensitivity of 91.67% and specificity of 77.78% for patients with Alvarado score ranging from 4 to 7, and appendiceal MOD ranging from 6 to 8 mm, while a discriminatory criterion of RI greater than 0.51 had a high sensitivity of 100% and a relatively lower specificity of 66.67%. The patients with AA have significantly higher point PSV and point RI values than those without AA and are especially useful in equivocal patients whose MODs and Alvarado scores are in the diagnostically equivocal ranges of 6-8 mm and 4-7, respectively, with the point PSV and RI demonstrating negative predictive value 87.5% and 100%.

Unexplored Dimensions in the Diagnosis of Acute Appendicitis: Beyond the Alvarado Score and Imaging Techniques

This exploratory discourse delves into overlooked aspects of acute appendicitis diagnosis, extending the conversation beyond conventional considerations such as the Alvarado score and imaging methods. As healthcare continues to evolve, understanding the nuances of this common abdominal condition becomes imperative. This text aims to shed light on unexplored dimensions, offering a more holistic perspective on acute appendicitis diagnosis.

Evaluation and comparison of the results of the Alvarado scoring system with acute inflammatory response score in the diagnosis of acute appendicitis based on the pathological evidence

Introduction: Although appendectomy is the most common reason for abdominal surgery, acute appendicitis (AA) diagnosis remained a challenging issue using various scoring systems. Objectives: The current study aims to investigate the diagnostic value of the Alvarado scoring system versus the acute inflammatory response score (AIRS) in the diagnosis of AA. Patients and Methods: The current cross-sectional study was conducted on 120 patients who underwent appendectomy between 2019 and 2020. The on-admission Alvarado and AIRS scores were evaluated for the patients. Besides, the histopathological study of the resected tissues was considered the gold standard. The receiver operating characteristics (ROC) curve was depicted for the scoring systems, and sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV), and area under the curve (AUC) were calculated. Results: The sensitivity, specificity, NPV, and PPV of Alvarado criteria for scores &gt;4 equaled 89.3%, 23.5%, 35.2%, and 89.3%, respectively. These amounts were calculated as 96.1%, 82.3%, 77.7%, and 97% for the AIRS, respectively. Moreover, at cut-points &gt;8, the sensitivity of 32.1%, specificity of 100%, PPV of 100%, and NPV of 15.7% have been measured for AIRS compared with 41.7%, 88.2%, 97.1%, and 29.4% for Alvarado, respectively. The measured AUC for AIRS and Alvarado criteria accounted for 0.81 and 0.72, respectively (P value &lt;0.05). Besides, 17 (14.16%) ones had a negative appendectomy. Conclusion: Based on the current study’s findings, both AIRS and Alvarado scoring systems were reliable means to diagnose appendicitis; however, AIRS was relatively superior considering its higher specificity and PPV in scores &gt;8 and higher sensitivity and NPV in scores &gt;4.

Neutrophil-to-lymphocyte ratio to improve the diagnostic performance of appendicitis inflammatory score and modified Alvarado score

Abstract: BACKGROUND: Acute appendicitis is a surgical emergency often encountered in clinical practice. Diagnosis is usually based on clinical judgment supplemented with a few baseline investigations. Neutrophil-to-lymphocyte ratio (NLR) is a novel, stable inflammatory marker reflecting the inflammatory status, superior to individual leukocyte parameters. OBJECTIVES: We aimed to study the introduction of NLR as an additional parameter in the appendicitis inflammatory score and modified the Alvarado score to improve the sensitivity and specificity in the diagnosis of acute appendicitis. MATERIALS AND METHODS: This was a retrospective study of clinical and laboratory data of 101 consecutive patients above the age of 18 years with a sudden onset of nontraumatic abdominal pain and a provisional clinical diagnosis of uncomplicated acute appendicitis, subsequently undergoing appendectomy. Findings on histopathological examination of the resected appendix were considered the gold standard. The NLR was calculated from the hemogram parameters for all patients. The receiver operating characteristic (ROC) curve was used to determine the threshold score levels and the performance characteristics of scoring systems. RESULTS: The median age was 27 (12.50) years, with male predominance (77.2%). The appendicitis inflammatory response (AIR) score, modified Alvarado score, and the NLR were all significantly higher among patients with histopathologically confirmed appendicitis (P &lt; 0.01). A new score developed by combining the NLR with the AIR score outperformed both the modified Alvarado score and the original AIR score, as evident by significant increase in the area under the ROC curve. NLR is a useful parameter, and its addition to the AIR score can help guide clinical management. CONCLUSION: The addition of NLR in AIR score can help in clinical management of appendicitis.

EVALUATION OF ALVARADO SCORE IN DIAGNOSIS OF ACUTE APPENDICITIS

Background: Abdominal pain is frequently caused by acute appendicitis, which can be diagnosed early and result in a lower morbidity and death rate. Improved diagnostic procedures should minimize the progression to complicated appendicitis as well as reduce the number of unwanted surgical interventions. However, even with the advancements in diagnostic laboratory tests and contemporary radiographic imaging, appendicitis diagnosis is still primarily clinical. Different scoring methods were developed to reduce the negative appendectomy rate and raise the positive diagnosis rate of appendicitis such as Alvarado score. The present study aimed to evaluate the sensitivity and specificity of the Alvarado score as a method for the diagnosis of acute appendicitis. Methods: A total of 146 operated cases of appendectomy in Zawia Medical Center, Libya were studied. All patients presented during a period from July 2018 to July 2019 with symptoms and signs of acute appendicitis, and after that, they were operated on by the conventional method of open appendectomy. The relevant data was collected and analyzed, and the efficiency of the Alvarado scoring system was assessed by calculating sensitivity, positive predictive value, and negative appendectomy rate. Results: In this study, 100% of patients reported pain as their primary presenting symptom; presentations occurred between one and seven days, with a mean of two days; 100% of patients had surgery; and the overall negative appendectomy rate in Alvarado ≥7 was 5% and 72.5% was the positive predictive value (PPV).Conclusion: Our findings suggest that the Alvarado score has a very high positive predictive value, i.e., diagnostic accuracy. Also, with the help of the Alvarado score, we can reduce the number of negative appendectomies. Besides that, this scoring system is an easy, simple, cheap, reliable, safe, and fast tool in the preoperative diagnosis of acute appendicitis and can work effectively in routine practice.

Comparative Study of Diagnostic Accuracy of Pelviabdominal Computed Tomography with Contrast versus Appendicitis Inflammatory Response Score in the Diagnosis of Acute Appendicitis

Comparative Study of Diagnostic Accuracy of Pelviabdominal Computed Tomography with Contrast versus Appendicitis Inflammatory Response Score in the Diagnosis of Acute Appendicitis

To evaluate the efficacy of the Alvarado scoring system as a preoperative diagnostic tool in acute appendicitis in relation to operative and histopathological findings

Background: Appendicitis is expected to occur in about 6% of people during their lifetime. The most useful diagnostic techniques are still routine medical history and examination; Post surgery, after the specimen has been examined histopathologically, the final diagnosis is achievable. Systems of scoring are useful and valid for separating acute appendicitis from generalized abdominal pain and can help reduce unwanted surgery, particularly in remote areas. Aims: 1. To evaluate the efficacy of the Alvarado scoring system as a preoperative diagnostic tool in acute appendicitis, in relation to operative and histopathological findings. 2. To determine the role of the Alvarado scoring system in cutting down the rate of negative appendicectomy without increasing morbidity and mortality. 3. To know the specificity and sensitivity of the Alvarado scoring system in the diagnosis of acute appendicitis. Methods: A prospective study of 50 patients who presented with symptoms and signs of acute appendicitis and suspected enough to warrant surgery for acute appendicitis admitted in DR. PSIMS &amp; RF under various surgical units from November 2018 to October 2020 were selected. Results: In our study, migratory pain was noted in 80% of patients in this study. In this study, anorexia was noted in 60% of cases, rebound tenderness was found in 82% of cases, 37% of cases with a fever over 99°F had appendicitis, 80% of patients had leukocytosis, and leukocyte shift to the left was observed. Sensitivity, specificity, and positive predictive value (PPV) were 77.2%, 66.6%, and 94.4% in this study. Conclusion: This study concluded that the Alvarado score is a reliable, cheap, and reproducible tool for the diagnosis of acute appendicitis in the emergency room.

Clinical Implications of Serum Bilirubin and Procalcitonin in the Diagnosis of Acute Appendicitis

Acute appendicitis remains a common surgical emergency with challenges in prompt and accurate diagnosis. Serum biomarkers have garnered attention for their potential role in aiding diagnostic accuracy. This paper aims to update the clinical implications of serum bilirubin and procalcitonin levels in diagnosing acute appendicitis. A systematic review of literature was conducted, encompassing studies that investigated the relationship between serum bilirubin and procalcitonin levels and acute appendicitis. The search strategy included electronic databases, resulting in a comprehensive analysis of relevant articles. The findings suggest a notable association between elevated serum bilirubin levels and the presence of acute appendicitis. Furthermore, procalcitonin exhibited promising diagnostic potential, demonstrating a significant correlation with the severity of appendicitis. Subgroup analyses revealed varied sensitivity and specificity values, indicating the need for further refinement in clinical application. The integration of serum biomarkers, specifically bilirubin and procalcitonin, into the diagnostic algorithms of acute appendicitis could potentially enhance the accuracy of clinical assessments. However, limitations in existing studies, such as heterogeneity in patient populations and differing assay methodologies, emphasize the necessity for standardized protocols and larger prospective trials. In conclusion, serum bilirubin and procalcitonin levels show promise as adjunctive tools in diagnosing acute appendicitis. Their incorporation into clinical practice warrants careful consideration and validation through larger-scale studies to delineate their precise diagnostic utility, thereby potentially optimizing patient care pathways in the context of this prevalent surgical condition. Keywords : Acute appendicitis, Bilirubin, Procalcitonin, Diagnosis, Clinical implications

Evaluation of Modified Alvarado Score Compared with Histopathological Diagnosis in Acute Appendicitis

Background: Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide, despite much advancement in abdominal surgery. A number of scoring systems have been advocated to minimize the number of negative appendectomies. However, Modified Alvarado Score System (MASS) is the most prominent and widely used one. Considering limited data regarding correlation between Modified Alvarado Score and post-operative histopathological findings, the study was designed to assess the usefulness of Modified Alvarado Score compared with histopathological report in diagnosis of acute appendicitis. Methods: This cross sectional observational study was conducted at the department of General Surgery, Mymensingh Medical College &amp; Hospital, Mymensingh. All of the admitted patients with acute appendicitis were approached for inclusion of the study. All patients who met the inclusion criteria were consecutively enrolled in the study. Prior final inclusion, informed written consent form was ensured. Ethical issues were maintained in according to the Declaration of Helsinki. Appendicectomy was done based on the overall clinical judgement. Pre-operative Modified Alvarado Score was assessed for all patient. The diagnosis was confirmed by histopathological examination. Data was collected by the researcher(me) and total 106 patients were included. Following collection, all data were sorted, checked and verified. After that data analysis was done by using SPSS statistical computer software (version 22). Results: A total number of 106 patients were studied. Their ages ranged from 12 to 51 years (mean 26.38±7.49 SD). There were 73.6% males and 26.4% females. All patients in this study underwent appendicectomy. Majority respondents had Modified Alvarado Score more than or equal to 7 (84%) and 16% had score below 7. According to histopathology findings, 14.16% respondents had normal appendix with or without other pathology and 85.84% had acute appendicitis. ....

A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis

A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis

Low-grade Appendiceal Mucinous Neoplasm Masquerading as Acute Appendicitis: A Case Report

Appendiceal mucinous neoplasms, particularly Low-grade Appendiceal Mucinous Neoplasms (LAMN), are rare but important diagnostic entities as they are potential causes of a surgical abdomen. The clinical manifestations of this lesion are obscure and ill-defined, and these lesions are commonly misdiagnosed as acute appendicitis, adnexal masses, or retroperitoneal tumours. This lesion can rupture and seed mucin and neoplastic epithelium into the peritoneum, leading to Pseudomyxoma Peritonei (PMP), a serious complication with a high morbidity and mortality rate. Therefore, timely identification and treatment of LAMN are crucial for reducing the risk of PMP and improving prognosis and outcomes. Ultrasonography (USG) and Computed Tomography (CT) scans are useful methods for diagnosis; however, the diagnosis is often incidental or found intraoperatively during resection for suspected acute appendicitis. Clinical awareness of the misleading presentations of LAMN should be present in cases of a surgical acute abdomen to prevent performing a dissimilar treatment intervention. Considering the rarity of this lesion and its varied presentation, it is important to study and document this type of neoplasia in the literature. Hereby, authors report a rare case of LAMN in a 33-year-old male patient with a primary diagnosis of acute appendicitis. This case highlights the importance of having a high index of clinical suspicion of appendiceal malignancy and mucocele rupture in patients planned for appendectomy. This also emphasises the fact that all excised appendicectomy tissues should be sent for histopathological examination as they can harbor pathological changes like LAMN.

Tzanaki’s Score Vs Modified Alvarado’s Score In Diagnosing Acute Appendicitis: A Comparative Study In A Tertiary Care Hospital

Introduction: Acute appendicitis is commonly diagnosed when a patient presents with pain in right iliac fossa. Various Scoring systems are used to diagnose acute appendicitis and mainly include the presenting signs and symptoms, but are not acceptable for patients. The purpose of this study was to assess effectiveness of modified Alvarado score and Tzanaki’s Score in the diagnosis of acute appendicitis. Methods: A prospective observational study was done in department of General Surgery JLN Medical College Hospital, Ajmer which incorporated 200 patients presenting with the signs and symptoms of acute appendicitis. Patients were evaluated by Modified Alvarado score and Tzanaki’s Score during admission and based on the treating surgeon’s decision, were operated. Finally, the score was compared with the diagnosis done by histopathological examination of the operated specimen. Results: The sensitivity &amp; specificity of Modified Alvarado Score was 84.26% &amp; 72.7% respectively with a positive predictive value of 96.15% &amp; negative predictive value of 36.3%. The sensitivity and specificity of Tzanaki’s score was 88.2% and 72.7% respectively with a positive predictive value of 96.31% and negative predictive value of 43.24%. The diagnostic accuracy of Alvarado score was 83% and that of Tzanaki’s score was 86.5%. Conclusion: Tzanaki’s scoring system can be used as an effective modality in the diagnosis of acute appendicitis. There is increased sensitivity and diagnostic accuracy in Tzanaki’s scoring when compared to modified Alvarado score.

Diagnosis of acute appendicitis by modified Alvarado score vs. ultrasound based on histopathological findings: A comparative study

Background: Acute appendicitis commonly causes emergency surgery. Clinical examination accuracy ranges from 71-97%; despite ultrasound diagnostic improvements, accuracy depends mainly on operator experience. This study uses a modified version of the Alvarado score, excluding one laboratory finding (shift to the left of neutrophil maturation). As differential count is not routinely undertaken in the study site (Erbil), patients were scored out of 9 rather than 10 points. This study compares the diagnostic accuracy of ultrasound and modified Alvarado score in the diagnosis of acute appendicitis, to reduce appendicitis mortality and morbidity, and reduce rates of negative appendicitis. Methodology: The study design was a prospective cross-sectional comparative study, which took place in the Surgery, Radiology and Histopathology Department of Rizgary Teaching Hospital and Rozhalat Emergency Hospital, Erbil, from January 2019 to December 2021. All patients who presented to the emergency room with signs and symptoms of acute appendicitis were clinically evaluated. Patients who had a modified Alvarado score &gt; 8 were considered positive for modified Alvarado, and those scoring 6-7 were considered negative for modified Alvarado and were considered for ultrasound examination; among the latter, those with positive ultrasound results were included in the study. Results: Among the 468 patients, 257 (54.9%) were male and 211 (45.1%) were female (1.22:1 male: female ratio), with a mean age of 23.45 ± 2.1 years (ranging from 12 to 56 years). Modified ultrasonography has a sensitivity of 82% and an accuracy of 79.9%; the modified Alvarado score had a sensitivity of 95.2% and an accuracy of 87%. There was no association between the mean age of male and female patients with the histopathological results. The most commonly affected age group was the cohort 21-30 years (51.7% of all patients). The number of patients with positive histopathology was 411; negative histopathology was recorded for 57 patients, with no association between histopathological results and gender. There was a significant association between symptoms (cough signs, localized tenderness signs, and pointing signs) and positive histopathology findings. Conclusion: Modified Alvarado score has higher sensitivity than ultrasound, while ultrasound has a higher specificity. Neither tool is superior to the other, nor both need to be used together to reduce negative appendectomy rates.

The Role of Magnetic Resonance Pulse Sequences in the Diagnosis of Acute Appendicitis in Pregnant Women.

Acute appendicitis (AA) is one of the most common surgical emergencies, with a lifetime risk estimated at 7-8%. Pregnant women with appendicitis can have a difficult diagnosis becausemany signs and symptoms could overlap with other causes of acute abdominal pain. Although magnetic resonance imaging (MRI) is not contraindicated at all gestational ages for units with a field strength of three Tesla or less, there is still much discussion regarding the best protocol to follow in order to minimize survey time and maximize diagnostic efficiency. The purpose of this study was to assess how well different MR pulse sequences can diagnose AA. This retrospective study involved 179 pregnant females. All patients treated and admitted to the University Medical Center, Ho Chi Minh City, Vietnam, between January 2016 and October 2023 had their MR scans and medical data examined. MRI results were assessed and compared with surgical and histopathological findings. The mean age of the population was 29.7 ± 4.8 years (range, 18-46 years). On T1-weighted (T1W) and T2-weighted (T2W) sequences, the appendix was clearly visualized at rates of 81.8% and 89.9%, respectively. The sensitivity and specificity of the T2W in diagnosing AA were 93.5% and 92.3%, and when combined with T1W and diffusion-weighted (DW) images, the sensitivity and specificity further increased, being 96.8% and 94.9%, respectively. The predictive value of non-AA of the T1 bright appendix sign was 95.6%. Our study supports the use of MRI as an imaging test to identify appendicitis during pregnancy, as it has been shown to be a useful method for diagnosing the condition in pregnant women. The T2W pulse sequence is a useful tool for diagnosing appendicitis because of its high sensitivity and specificity. When identifying appendicitis from T2W alone proves challenging, T1W with the T1 bright sign and DW to take advantage of the appendix lumen and/or wall's diffusion features can yield additional information and boost diagnostic confidence.

Evaluation of the Efficiency of Four Different Scoring Systems in the Diagnosis of Acute Appendicitis

Objective: The aim of this study was to investigate the effectiveness of four commonly used scoring systems (Alvarado, Lintula, RIPASA, Tzanakis) in the diagnosis of acute appendicitis in patients to be operated for acute appendicitis.&#x0D; Materials and Methods: We compared the results and efficacy of the scoring systems with the results of patients with an accurate histopathologic diagnosis of acute appendicitis.&#x0D; Results: A total number of 115 patients were included in the study (62 male and 53 female). For Alvarado, Lintula, RIPASA and Tzanakis scoring systems, sensitivity was 93.6%, 91.4%, 93.6%, 55.3%, specificity was 71.4%, 90.4%, 81%, 76%, Positive Predictive Value (PPV) was 93.6%, 97.7%, 95.7%, 91.2%, Negative Predictive Value (NPV) was 71.4%, 70.3%, 74%, 27.6%, respectively.&#x0D; Conclusion: Our findings show that among the four scoring systems, Alvarado, Lintula and RIPASA scoring systems are more effective scoring systems in diagnosing acute appendicitis whereas Tzanakis scoring system had a low diagnostic efficiency. Since ultrasonography findings have a high impact on Tzanakis scoring system, by working with an experienced radiology clinic, Tzanakis scoring system could be also a powerful scoring system at the diagnostic stage. None of the four scoring systems has 100% predictive accuracy in the diagnosis of acute appendicitis and all scoring systems have some shortcomings. Nevertheless, we believe that the most important criteria in the diagnostic process are the clinic where the patients are admitted, the examination findings and the experience of the clinician. Scoring systems seem to support the diagnosis and guide the clinician.