Graded Compression Sonography Research Articles

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum.

The Borderline-Size Appendix: Grayscale, Color Doppler, and Spectral Doppler Findings That Improve Specificity for the Sonographic Diagnosis of Acute Appendicitis.

Diagnostic criteria for acute appendicitis using graded compression sonography have been well established based on the maximum outer diameter (MOD) of the appendix, with MOD values of <6 mm nearly always indicating normal appendices and MOD values of >8 mm nearly always indicating appendicitis. However, the "borderline-size" appendix, meaning one whose MOD lies between these ranges (ie, an appendix with MOD of 6-8 mm), presents a diagnostic dilemma because appendices in this size range are neither clearly normal nor abnormal when diagnosis is based on the MOD alone; accordingly, such borderline MOD values are diagnostically equivocal, and sonographic diagnosis must rely on sonographic findings other than the MOD. The goal of this review was to examine the additional sonographic findings that can add specificity and help enable an accurate diagnosis to be made in patients with borderline-size appendices.

Discovering The True Accuracy of Ultrasonography in The Confirmation of Diagnosis of Acute Appendicitis, a World-wide Dilemma

Background: Acute appendicitis occurs in almost 10 % of western populations. The male-female ratio of approximately 2:1 gradually declines after age 25 years until the gender ratio is equal. Approximately 1% of total surgical procedures are appendectomies. Negative appendectomy rates are increasing and some of the factors that play a massive role in this include clinical evaluation that is not specific and absence of readily available techniques permitting direct visualization of the appendix. Because of this world-wide problem of increasing negative appendectomies, we need a method to confirm the diagnosis of true acute appendicitis.Objective: This study was conducted to evaluate and estimate the efficacy of ultrasound in the confirmation of diagnosis of acute appendicitis in clinically suspected cases of acute appendicitis and to compare ultrasound findings with surgical findings.Methods: This study included a total of 100 patients suspected to have acute appendicitis who were admitted to the department of surgery at Al-Karak teaching hospital, Mutah University, from January 2014- December 2015. Abdominal-pelvic sonography with focus on the right lower quadrant graded compression ultrasonography technique was used. The sonographic data was prospectively correlated with clinical operative and histopathological findings.Results: Graded compression ultrasonography results were analyzed and showed 92.7% sensitivity, 94.5% specificity, 93% accuracy, 94.4% positive predictive value, 92.5% negative predictive value.Conclusion: Ultrasonography has a higher degree of accuracy so it is a safe and a reliable method in the diagnosis of suspected cases of acute appendicitis. This can help minimize negative appendectomies, perforation rates, and medical expenses on patients. Therefore from the findings in our study, we may begin to put this world-wide issue to rest.

A Retrospective Comparison Study of Ultrasonography and Computed Tomography Scan in Diagnosis of Acute Appendicitis in the Pediatric Population

Background: Ultrasonography (US) has largely become the primary diagnostic imaging modality for the diagnosis of acute appendicitis (AA) in pediatric patients. The purpose of this study was to determine and compare the diagnostic accuracy of helical computed tomography (CT) scans and graded compression US for the diagnosis of AA in the pediatric population. Methods: Between January 2011 and December 2013, 431 pediatric patients (aged 5 - 18 years) who presented with acute abdominal pain and received either a CT scan, US, or both for the diagnosis of AA were retrospectively reviewed from an IRB-approved institution-wide database. Sensitivities and specificities of both imaging modalities were calculated and compared. Results: Patients were allocated into two cohorts depending on whether they received an US (239/431) or CT (192/431). Clinical symptoms and laboratory values were noted and analyzed for the significance of mesenteric lymphadenitis in conjunction with appendicitis and for differential diagnosis. A total of 182 CT cases and 227 US cases were verified as appendicitis via histopathology report. The overall sensitivity and specificity of CT imaging were determined to be 91.2% and 70%, respectively, while the sensitivity and specificity for US imaging were 52.8% and 83.3%. Conclusion: Helical CT imaging in the pediatric population has provided a higher sensitivity and diagnostic accuracy for AA. However, the diagnostic benefit of US cannot be excluded in this patient population. Further research is needed on whether CT imaging should be used primarily for the diagnostic approach to AA in pediatric patients complaining of acute abdominal pain. J Curr Surg. 2020;10(3):21-27 doi: https://doi.org/10.14740/jcs404

Sonography of the Cecum: Gateway to the Right Lower Quadrant.

Sonography of the cecum has come of age largely as a consequence of the successful evolution of appendiceal sonography as a useful tool in the evaluation of patients with right lower-quadrant pain. At some medical centers, graded-compression sonography (GCS) has become the initial imaging study of choice in the assessment of these individuals. The cecum serves as a helpful anatomic landmark for localization of the appendix in these examinations-providing a sonographic starting point in the search for the appendix. During GCS, primary pathology within the cecum itself can become evident, including a variety of processes, such as infectious, inflammatory, or neoplastic disorders, whose presentations commonly mimic that of appendicitis. The accurate diagnosis of cecal abnormalities and their differentiation from acute appendicitis play valuable roles in the management of affected patients because the options for further workup and subsequent treatment vary greatly according to the diagnosis at hand. Additionally, the compressed cecum often becomes an acoustic window into the right lower quadrant, revealing pathology apart from the appendix within the right iliac fossa. The purpose of this pictorial essay is to highlight the importance and value of performing a careful evaluation of the cecum during GCS of patients with suspected appendicitis and to review the differential diagnosis and imaging findings of primary cecal abnormalities whose clinical presentations can mimic that of acute appendicitis.

Practical Imaging Strategies for Acute Appendicitis in Children.

Diagnosing pediatric appendicitis is difficult because clinical findings are nonspecific. Improved accuracy can be obtained with ultrasound (US), CT, or MRI, despite considerable variation in their use at different institutions. This article reviews the evidence for best practices in imaging pediatric appendicitis. When each modality is optimally used, a stepwise imaging approach that begins with graded compression US and proceeds to CT or MRI in select cases is currently best practice.

A Study on Comparision of Diagnostic Efficiency between Modified Alvarado Score and Graded Compression Ultrasonography in the Case of Acute

A Study on Comparision of Diagnostic Efficiency between Modified Alvarado Score and Graded Compression Ultrasonography in the Case of Acute

A Study on Comparision of Diagnostic Efficiency between Modified Alvarado Score and Graded Compression Ultrasonography in the Case of Acute Appendicitis

A Study on Comparision of Diagnostic Efficiency between Modified Alvarado Score and Graded Compression Ultrasonography in the Case of Acute Appendicitis

Role of color Doppler imaging in borderline size appendix-Simple method to improve specificity for appendicitis

Aims and objective:To differentiate between the normal appendix from inflamed appendix on color Doppler imaging.Continuous intramural vascular signal measuring at least 3mm on color Doppler imaging is highly specific forappendicitis in borderline-size appendix.Materials and method:Equipment and Method:All patients were scanned with a single ultrasound machine and 9–15-MHz transducers (GE Healthcare).Study design:Prospective studySample size:50 patients referred to radiology dept with possible appendicitis from 2015 to 2017.Source of the data:Patients coming to the department of radio diagnosis at SSIMS & RC Davangere with a clinical history of painand tenderness in RIF and all patients who had undergone graded-compression sonography for possibleappendicitis and whose appendices were of diagnostically borderline size (6–8 mm maximum outer diameter).Results:Of the 50 patients, 17had type 1 flow (of whom 3 had appendicitis); 13 had type 2 flow (of whom 11 hadappendicitis); and 20had absent flow (of whom 5had appendicitis).Conclusion:Graded-compression US remains our first-line method in the evaluation of patients referred with clinicallysuspected acute appendicitis.Type II flow (Continuous linear or curvilinear flow >3mm) within the wall of the appendix is highly specific,yet insensitive, for appendicitis in borderline sized appendix.Type I flow (Punctuate dispersed signal) is neither sensitive nor specific for appendicitis and can be seennormal appendix.

Anatomic Reasons for Failure to Visualize the Appendix With Graded Compression Sonography: Insights From Contemporaneous CT.

The purpose of this study is to identify the anatomic locations of appendixes on CT when graded compression sonography fails to visualize the appendix. The study included 197 patients with suspected appendicitis whose appendixes were not visualized on graded compression sonography performed with typically used transducers of at least 10 MHz, who underwent CT within 48 hours following graded compression sonography, and who had available either pathologic examination following surgery or 6-week follow-up if surgery was not performed. Appendixes were retrospectively localized using four transverse quadrants (including the posteromedial quadrant) centered on the ileocecal valve and projected vertically, the craniocaudal level relative to the iliac crests, and the depth of the appendix as measured from the surface of the skin. Data were assessed using the Fisher exact test, t test, multinomial test, binomial distribution, ANOVA, and linear regression. Appendixes were most frequently located in the posteromedial quadrant (123 of 197 patients [62.4%]; 95% CI, 55.3-69.2%) at a statistically significantly greater frequency than that expected by chance (p < 0.00001). Appendixes were located above the iliac crests in 19.8% of patients (39/197; 95% CI, 14.5-26.1%) and at depths exceeding the penetration of typical transducers of at least 10 MHz in 19.3% of patients (38/197; 95% CI, 14.0-25.5%). All appendixes (95% CI, 98.1-100.0%) were located within the range of 6-MHz transducers. Appendixes that are not visualized on graded compression sonography are most frequently located in the posteromedial quadrant and are often located above the iliac crests or at depths too great for visualization with typically used transducers of at least 10 MHz. Accordingly, when the appendix is not visualized on graded compression sonography, targeted scanning of the posteromedial quadrant and the region above the iliac crests, and scanning with 6-MHz transducers, may enable visualization of the appendix and are recommended additions to scanning protocols.

Spectral Doppler Waveforms for Diagnosis of Appendicitis: Potential Utility of Point Peak Systolic Velocity and Resistive Index Values.

Purpose To test the hypothesis that appendiceal spectral Doppler waveforms can distinguish patients with and patients without appendicitis. Materials and Methods In this retrospective study, Doppler waveforms were obtained from intramural appendiceal arteries identified with color Doppler imaging in 60% (93 of 155) of consecutive patients whose appendices were visualized at graded compression ultrasonography (US) performed for suspected appendicitis (53 male and 40 female; age, 1-56 years; mean, 14.5 years) over the 5-month period from November 2015 through March 2016. Point, non-angle-corrected peak systolic velocity (PSV) and resistive index (RI) values were compared between patients with and patients without appendicitis by utilizing histopathologically proven appendicitis and 6-week clinical follow-up as diagnostic reference standards. Data were assessed by using the Student t test, exact binomial distribution, two-sample test of proportions, and receiver operating characteristic analysis. Results Among the 93 patients, 36 (38.7%) had proven appendicitis (mean PSV, 19.7 cm/sec; mean RI, 0.69) and 57 patients (61.2%) did not (mean PSV, 7.1 cm/sec, P < .0001; mean RI, 0.50, P < .0001). The area under the receiver operating characteristic curve for the diagnosis of appendicitis was 0.97 (95% confidence interval [CI]: 0.95, 1.00) for PSV and 0.86 (95% CI: 0.78, 0.95; P = .011) for RI. Chosen discriminatory criteria of PSV greater than 10 cm/sec and RI greater than 0.65 yielded specificity for appendicitis of 94.7% and 96.5% with sensitivity of 88.9% and 63.9% (P = .013) and negative predictive value of 93.1% and 80.9% (P = .045), respectively. Original clinical graded compression US interpretations based on established US findings demonstrated specificity of 96.2% and sensitivity of 100.0%. Considering the subset of 20 patients whose maximum outer diameter measured 6-8 mm, the discriminatory criteria of PSV greater than 10 cm/sec and RI greater than 0.65 yielded specificity for appendicitis of 88.9% each, with sensitivity of 100.0% and 63.6% and negative predictive value of 100.0% and 66.6%, respectively. Conclusion In patients with visualized appendices at US, those with appendicitis exhibit significantly higher point PSV and point RI values than do patients without appendicitis and are distinguishable with high specificity by using a PSV greater than 10 cm/sec and an RI greater than 0.65 as diagnostic criteria. © RSNA, 2017.

To Evaluate the Efficacy of Alvarado Score and Ultrasonography in Acute Appendicitis

Alvarado score is an objective assessment of right lower quadrant pain. Alvarado score is based on sophisticated statistical analysis of symptoms, signs and laboratory data in acute appendicitis. The score ≥ 7 indicates high probability of acute appendicitis. Practically speaking, it is equivalent to ones degree of clinical suspicion. Therefore this scoring system is used to reach the clinical diagnosis. It is considered that use of the scoring system to make the clinical diagnosis would allow uniformity as more than one senior surgical resident are involved in making the decision. Other studies have shown that Alvarado score has the accuracy of 88%. Graded compression ultrasonography in diagnosis of acute appendicitis has greatly improved the ability to diagnose acute appendicitis with ultrasound. Graded compression sonography plays an important role in reducing the number of negative surgical exploration for acute appendicitis. The accuracy offered by sonography should keep negative laparotomy ratio at approximately 10%.

The role of preoperative graded compression ultrasound in detecting acute appendicitis and influencing the negative appendectomy rate.

The diagnosis of acute appendicitis is mainly clinical and is correct in about 80% of patients, but 20-33% present with atypical findings, which resulted in a negative appendectomy rate of 20-30%. The graded compression ultrasound method in the diagnosis of acute appendicitis was reported with a sensitivity of 89%, and specificity of 95%. In this study, we aim to evaluate the graded compression ultrasonography in the diagnosis of acute appendicitis, its influence on the clinical judgment to operate, and its role in lowering the negative appendectomy rate. 1073 patients treated surgically for acute appendicitis between January 2005 and December 2014 were reviewed. Ultrasound findings, histopathological diagnosis, and positive or negative appendectomy rates were analyzed. 647 (60.3%) patients were males and 426 (39.7%) females. The mean age was 26.5years. Positive ultrasound findings were recorded in 892 (83.13%), while negative findings were recorded in 181 (16.87%). Positive appendectomy was recorded in 983 (91.6%), while negative appendectomy was recorded in 90 (8.4%). The sensitivity was 83%, specificity was 100%, and the rate of negative appendectomy was 8.39%. Graded compression technique of ultrasound is a useful modality, in addition to the clinical judgment of the surgeon and clinical findings, in detecting true positive cases of acute appendicitis, and thus reducing the negative appendectomy rate. Values of 100% specificity, and 8.4% negative appendectomy rate, or better, could be achieved, when an experienced surgeon and a professional radiologist collaborate in the diagnosis of acute appendicitis.

How to diagnose acute appendicitis: ultrasound first.

Acute appendicitis (AA) is a common abdominal emergency with a lifetime prevalence of about 7 %. As the clinical diagnosis of AA remains a challenge to emergency physicians and surgeons, imaging modalities have gained major importance in the diagnostic work-up of patients with suspected AA in order to keep both the negative appendectomy rate and the perforation rate low. Introduced in 1986, graded-compression ultrasound (US) has well-established direct and indirect signs for diagnosing AA. In our opinion, US should be the first-line imaging modality, as graded-compression US has excellent specificity both in the paediatric and adult patient populations. As US sensitivity is limited, and non-diagnostic US examinations with non-visualization of the appendix are more a rule than an exception, diagnostic strategies and algorithms after non-diagnostic US should focus on clinical reassessment and complementary imaging with MRI/CT if indicated. Accordingly, both ionizing radiation to our patients and cost of pre-therapeutic diagnosis of AA will be low, with low negative appendectomy and perforation rates.Main Messages• Ultrasound (US) should be the first imaging modality for diagnosing acute appendicitis (AA).• Primary US for AA diagnosis will decrease ionizing radiation and cost.• Sensitivity of US to diagnose AA is lower than of CT/MRI.• Non-visualization of the appendix should lead to clinical reassessment.• Complementary MRI or CT may be performed if diagnosis remains unclear.

Role of Graded Compression Ultrasonography in Evaluation of Acute Appendicitis.

Introduction: Acute appendicitis is common surgical emergency which can lead to high morbidity and mortalityin absence of timely treatment. Ultrasonography (USG) is commonly used to diagnose appendicitis and excludeother intraabdominal pathology leading to right iliac fossa pain in emergency setting. We aimed to Þ nd out thediagnostic value of graded compression USG in suspected appendicitis cases.Methods: Altogether 107 patients with clinical impression of acute appendicitis were followed. Four caseswere excluded because of other diagnosis established in USG. Appendicitis was diagnosed by standard criteriasof inß ammed appendix by graded compression technique. Informations of 103 cases were recorded in proformawhich was later entered in SPSS and statistical calculations done.Results: Out of 103 cases followed, 93 had appendicitis. Of those, 46 cases only showed inß ammed anddistended appendix, others showed ancillary features only. Males were more affected 61(65.6%) than females.Sensitivity, speciÞ city, positive predictive value, negative predictive value and accuracy of ultrasound indetecting appendicitis were 98.9%,90%,98.9%,90% and 97.1% respectively.Conclusions: Graded compression ultrasonography is good investigation modality in assessement of suspectedacute appendicitis.doi: http://dx.doi.org/10.3126/mjsbh.v12i2.12929

Importance of ultrasonography and colour doppler in evaluation of bowel pathology in clinically suspected cases.

Background: High resolution ultrasonography and colour doppler have become valuable diagnostic modalities for the evaluation of bowel pathology. Study was done to evaluate importance of ultrasound with colour doppler in bowel pathology arising from duodenum to rectum. Materials and Methods: A prospective study of 160 patients was done with bowel pathology during July 2013 to December 2014. The study group consists of patients who presented with clinical signs and symptoms pertaining to pathology arising from the duodenum, small bowel, large bowel and appendages. Detailed history was taken before the sonography examination. Results: In our study, out of 160 patients of bowel lesions, 42 patients (26.2%) were under 32 to 40 years age group. Pain in abdomen was the commonest presentation found in 149 patients (93.1%). Infection and Inflammatory lesions were the commonest bowel pathology detected in 109 patients (68.1%), among them appendicitis &amp; its complication was the commonest pathology followed by abdominal tuberculosis. Neoplasm was 2nd most common pathology which constituted 28 patients (17.5%). The commonest malignant lesion was adenocarcinoma diagnosed in 19 patients (70%). Conclusion: Ultrasonography (USG) is the primary investigation of choice in the patients with pain in abdomen. The use of endosongraphy proved to be essential in detecting and staging rectosigmoid malignancy. Hydrocolon technique and fluid aided sonography also helped in delineating colonic masses. High frequency graded compression sonography proved to be essential in case with acute appendicitis.

Three-step sequential positioning algorithm during sonographic evaluation for appendicitis increases appendiceal visualization rate and reduces CT use.

The purpose of this article is to examine the rates of appendiceal visualization by sonography, imaging-based diagnoses of appendicitis, and CT use after appendiceal sonography, before and after the introduction of a sonographic algorithm involving sequential changes in patient positioning. We used a search engine to retrospectively identify patients who underwent graded-compression sonography for suspected appendicitis during 6-month periods before (period 1; 419 patients) and after (period 2; 486 patients) implementation of a new three-step positional sonographic algorithm. The new algorithm included initial conventional supine scanning and, as long as the appendix remained nonvisualized, left posterior oblique scanning and then "second-look" supine scanning. Abdominal CT within 7 days after sonography was recorded. Between periods 1 and 2, appendiceal visualization on sonography increased from 31.0% to 52.5% (p < 0.001), postsonography CT use decreased from 31.3% to 17.7% (p < 0.001), and the proportion of imaging-based diagnoses of appendicitis made by sonography increased from 63.8% to 85.7% (p = 0.002). The incidence of appendicitis diagnosed by imaging (either sonography or CT) remained similar at 16.5% and 17.3%, respectively (p = 0.790). Sensitivity and overall accuracy were 57.8% (95% CI, 44.8-70.1%) and 93.0% (95% CI, 90.1-95.3%), respectively, in period 1 and 76.5% (95% CI, 65.8-85.2%) and 95.4% (95% CI, 93.1-97.1%), respectively, in period 2. Similar findings were observed for adults and children. Implementation of an ultrasound algorithm with sequential positioning significantly improved the appendiceal visualization rate and the proportion of imaging-based diagnoses of appendicitis made by ultrasound, enabling a concomitant decrease in abdominal CT use in both children and adults.

Value of short-interval computed tomography when sonography fails to visualize the appendix and shows otherwise normal findings.

The purpose of this study was to evaluate the type and incidence of disorders revealed by short-interval computed tomography (CT) in patients with suspected appendicitis after graded compression sonography fails to reveal the appendix and shows otherwise normal findings. Computed tomographic findings and clinical courses were assessed retrospectively for 318 patients identified consecutively in a searchable database who met inclusion criteria specifying that sonography was the initial imaging examination for suspected appendicitis; sonography revealed nonvisualization of the appendix and otherwise normal results; and abdominopelvic CT was performed within 48 hours after sonography. Of the 318 patients, short-interval CT revealed normal findings in 250 (78.6%). Appendicitis was revealed in 52 (16.4%) others, of whom 7 had perforation and all of whom had pathologic results confirming these CT findings. Important alternative diagnoses other than appendicitis were revealed in 16 (5.0%) others, including 2 (0.6%) who required urgent surgery and 14 (4.4%) who did not. No significant differences were observed between adult patients (>18 years) and pediatric patients. Most short-interval CT scans in this clinical setting reveal normal findings, and relatively few disclose appendicitis or disorders that require urgent surgery. In view of concerns regarding radiation exposure associated with CT, these observations argue for the development of clinical triage methods that differentiate patients who are likely to benefit from short-interval postsonography CT from those who are not.

Limits and advantages of abdominal ultrasonography in children with acute appendicitis syndrome.

Graded compression ultrasonography (US) has become the most popular technique used in suspected appendicitis and in our prospective study, we have evaluated its contribution to the diagnosis of acute appendicitis during the period 2010-2013. Four hundred and eighty children underwent urgent abdominal suspected of having acute appendicitis. Patients were divided into operated groups; (220 patients) and non-operated (260 patients) the final diagnosis was established on histopathological findings in the first group and on the phone interview in the second one. US was the sole imaging modality in all the non-operated patients and in 203 out of 220 operated ones. Seven children in the operated group underwent CT, while a second US was performed in 10 patients. Acute appendicitis was confirmed in 188 operated patients while no one in the non-operated group returned to the hospital or was operated for appendicitis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 79%, 78%, 95%, 39% and 79%, respectively. Negative appendectomy and perforation rates were 14% and 8%. Seventeen children in the operated group required a second diagnostic imaging: 7 CTs and 10 USs. All the seven CTs were consistent with appendicitis and 6 out of 10 USs showed ecographic signs of appendicitis. Our results support routine US in all the children with suspected appendicitis because it helps in reducing negative appendectomy and perforation rate. Moreover, a negative US does not justify a subsequent and immediate CT because clinical re-evaluation and a second US can clarify the diagnosis.

DIAGNOSTIC EFFICACY OF MODIFIED ALVARADO SCORE OVER GRADDED COMPRESSION ULTRASONOGRAPHY

Abstract Background: Acute appendicitis is one of the commonest surgical emergencies. Despite a life time cumulative risk of nearly 7% its diagnosis remains a challenge. The risks of two primary outcomes must be balanced in the management of presumed appendicitis: perforation and misdiagnosis.The rate of misdiagnosis in certain populations is as high as 40%. Diagnostic aids like modified Alvarado score and ultrasonography can dramatically reduce the negative appendicectomies. Methods:Data was collected from 60 patients with complains of right iliac fossa pain over a period of 9 months to our hospital. All patients were categorised using the Alvarado score and Graded compression ultrasonography was done. The preoperative and histological findings were compared with the preoperative diagnosis. The collected data was analysed with regards to various parameters like sensitivity, specificity, predictive values and diagnostic accuracy. Results:In our study of 60 patients, 56 patients underwent appendicectomy out of which a histological confirmation of appendicitis was obtained for 50 patients, giving a negative appendicectomy rate of 12%.By taking a cut-off point of 7 for the Modified Alvarado score, a sensitivity of 97.56%, specificity of 66.67%, positive predictive value (PPV) of 95.23%, negative predictive value (NPV) of 80% and accuracy of 87.2% were calculated. Using the cut-off point of 6, a sensitivity of 90% specificity of 50%, PPV of 69.23%, NPV of 80% and accuracy of 55.56% were obtained. The sensitivity, specificity, PPV, NPV and accuracy rate of ultrasonography was 92.15%, 88.9%, 97.19%, 66.7% and 85%, respectively. Conclusion:The presence of a modified Alvarado score &gt; 7 was found to be a dependable aid in the preoperative diagnosis of acute appendicitis. In cases where the score was negative or equivocal, ultrasonography greatly helped in the diagnosis thereby reducing the incidence of negative appendicectomies.