Preliminary Diagnosis Of Acute Appendicitis Research Articles

The diagnostic value of serum hepcidin in acute appendicitis.

Acute appendicitis (AA) is the primary cause of acute abdomen in patients presenting to the emergency department with abdominal pain. Limited studies have explored the relationship between serum hepcidin levels and AA. This study aimed to measure serum hepcidin levels in patients undergoing surgery with a preliminary diagnosis of AA and to assess whether these levels can serve as a biochemical marker for diagnosing AA. This study included patients aged 18 or older who presented to the emergency department between April 2018 and May 2019 and underwent surgery with a diagnosis of AA. The cohort comprised 94 patients with surgical pathology results compatible with AA (Group A), 16 patients with results not compatible with AA (Group B), and 42 healthy controls. Serum hepcidin levels were measured from venous blood samples. Mean hepcidin levels were 1750±285 pg/mL in Group A, 1349±381 pg/mL in Group B, and 1066±225 pg/mL in the control group. Statistically significant differences in serum hepcidin levels were observed between Group A and the control group (p<0.05). Hepcidin levels were significantly higher in patients with AA compared to both the control group and patients with surgically confirmed non-AA pathology. Therefore, hepcidin may serve as a useful adjunct in diagnosing acute appendicitis.

Can Appendiceal Neoplasms Be Predicted in Patients with Presumed Acute Appendicitis?

Objective: The detection of malignancy in the final pathology report of patients undergoing surgery for acute appendicitis is a nasty surprise for both the patient and the clinician. To improve the management of this situation, we analyzed clues for predicting possible neoplasms. Methods: We analyzed in detail the data of patients operated on in our department with a preliminary diagnosis of acute appendicitis over 42 months. The group whose final pathology was reported as primary appendiceal neoplasm was compared with the acute appendicitis group. Results: Appendiceal neoplasm was detected in 16 patients (1%). Half of these were mucinous epithelial neoplasms. Neuroendocrine tumors (18.7%) were the second most common neoplasm. According to the logistic regression model, low hemoglobin level (p&lt;0.01) and low Alvarado score (p:0.02) were the two most valuable factors in the prediction of primary appendiceal neoplasms. Laboratory findings of high neutrophil/lymphocyte ratio (p&lt;0.01) and plastron formation on imaging (p:0.03) were more common in the neoplasm group. Advanced age, comorbidity, immunosuppression and inflammatory bowel diseases (IBD) were other characteristics of the neoplasm group. Conclusions: Appendiceal neoplasms should always be considered in anemic patients with relatively low Alvarado scores.

Prediction of Perforated and Nonperforated Acute Appendicitis Using Machine Learning-Based Explainable Artificial Intelligence

The primary aim of this study was to create a machine learning (ML) model that can predict perforated and nonperforated acute appendicitis (AAp) with high accuracy and to demonstrate the clinical interpretability of the model with explainable artificial intelligence (XAI). A total of 1797 patients who underwent appendectomy with a preliminary diagnosis of AAp between May 2009 and March 2022 were included in the study. Considering the histopathological examination, the patients were divided into two groups as AAp (n = 1465) and non-AAp (NA; n = 332); the non-AAp group is also referred to as negative appendectomy. Subsequently, patients confirmed to have AAp were divided into two subgroups: nonperforated (n = 1161) and perforated AAp (n = 304). The missing values in the data set were assigned using the Random Forest method. The Boruta variable selection method was used to identify the most important variables associated with AAp and perforated AAp. The class imbalance problem in the data set was resolved by the SMOTE method. The CatBoost model was used to classify AAp and non-AAp patients and perforated and nonperforated AAp patients. The performance of the model in the holdout test set was evaluated with accuracy, F1- score, sensitivity, specificity, and area under the receiver operator curve (AUC). The SHAP method, which is one of the XAI methods, was used to interpret the model results. The CatBoost model could distinguish AAp patients from non-AAp individuals with an accuracy of 88.2% (85.6-90.8%), while distinguishing perforated AAp patients from nonperforated AAp individuals with an accuracy of 92% (89.6-94.5%). According to the results of the SHAP method applied to the CatBoost model, it was observed that high total bilirubin, WBC, Netrophil, WLR, NLR, CRP, and WNR values, and low PNR, PDW, and MCV values increased the prediction of AAp biochemically. On the other hand, high CRP, Age, Total Bilirubin, PLT, RDW, WBC, MCV, WLR, NLR, and Neutrophil values, and low Lymphocyte, PDW, MPV, and PNR values were observed to increase the prediction of perforated AAp. For the first time in the literature, a new approach combining ML and XAI methods was tried to predict AAp and perforated AAp, and both clinical conditions were predicted with high accuracy. This new approach proved successful in showing how well which demographic and biochemical parameters could explain the current clinical situation in predicting AAp and perforated AAp.

The role of neutrophil-albumin ratio in the diagnosis of acute appendicitis and its efficacy in predicting perforation.

Acute appendicitis (AA) is one of the most common causes of abdominal pain in patients presenting to the emergency department with abdominal pain, and despite developments in radiological imaging for its diagnosis, researchers are still in pursuit of a simpler, cheaper, and safer biomarker. Our study investigated the usability of the neutrophil-albumin ratio, a biomarker that predicts prognosis in cases with severe inflammation, in diagnosing AA and anticipating perforation. Our study is a retrospective and cross-sectional study. The study was conducted with patients who presented to the emergency department between January 2018 and December 2020 and were hospitalized with a preliminary diagnosis of AA. The cases were first divided into two groups as 'Not appendicitis' and 'AA,' and then the patients with 'AA' were divided into two subgroups as 'Perforated' and 'Non-perforated.' The demographic data of the patients, their symptoms, physical examination findings, and the decision-making process for surgery were noted. The neutrophil count and albumin levels detected in the blood samples obtained at the time of admission to the emergency department were noted. Afterward, the neutrophil-albumin ratio (NAR) was calculated and the cutoff level was determined to predict the diagnosis of AA and the development of perforation. The rate of complaints of pain in the periumbilical region was significantly higher in the patient group without AA compared to the patients in the AA group (70.6% and 40.3%, p=0.034). Although the leukocyte count, neutrophil count and percentage, and NAR were significantly higher in the AA group, the lymphocyte count was found to be significantly lower (p=0.005). However, no significant correlation was found between the NAR and the development of perforation (p=0.697). The NAR is useful for the diagnosis of AA. Nevertheless, it is not a sufficient biomarker for detecting perforation.

The Bedel Score: Suggesting a New Scoring System to Avoid Negative Appendectomy

Introduction: Scoring systems are still valuable and valid for differential diagnosis of acute appendicitis (AA). Bedel Score is a new diagnostic tool with 7 parameters that can be easily applied. The aim of this study is to determine the diagnostic performance of the Bedel score in AA and compare it with the Alvarado score. Methods: Our study consisted of 95 patients as a prospective cohort who were admitted to our emergency department due to abdominal pain and were hospitalized with a preliminary diagnosis of AA. Bedel and Alvarado scores were calculated. The patients were categorized into two groups (positive and negative appendectomy) according to their histopathological diagnosis. Results: The study population consisted of 65 (68.4%) male and 30 (31.6%) female patients. The mean age of the patients was 34 (18-87) years. 81 (85.3%) of the patients had histopathologically confirmed AA. Median Alvarado score was significantly higher in patients with positive AA than those with negative AA (7 (range: 3-10) vs. 5 (range 3-7), p&lt;0.001, respectively). Median Bedel score of positive AA patients were also significantly higher than those with negative AA (9 (range: 6-10) vs. 5 (range 2-8) p&lt;0.001, respectively) In separating acute appendicitis from negative exploration, the threshold of the Alvarado score is 63% sensitivity for ?7, 85.7% specificity; The Bedel score had 80.2% sensitivity and 92.9% specificity for the threshold value ?7. Conclusion: Bedel score is fast, simple, easy to learn and apply, as well as an effective and practical scoring system with only 7 parameters. Keywords: Acute appendicitis, Alvarado score, New score, Negative appendectomy

An investigation into the factors predicting acute appendicitis and perforated appendicitis.

To investigate the factors predicting acute appendicitis (AAp) and perforated AAp in patients who underwent surgery with a preliminary diagnosis of AAp. Between May 2009 and December 2018, 1316 patients underwent appendectomy with a presumed diagnosis of AAp. To investigate the factors predicting AAp, patients were divided into two groups considering the histopathological presence of inflammatory changes in the appendix: AAp positive (AAp group; n=1043) and AAp negative (Non-AAp group; n=273). Also, to investigate the factors predicting appendiceal perforation, patients with AAp were divided into two groups considering the presence of perforation: non-perforated AAp (n=850) and perforated AAp (n=193). ROC curve analysis was used to identify optimum cut-off values of quantitative variables. The groups were compared using univariate analysis methods and parameters with a p≤ 0.20 were taken into a multivariate logistic regression model. Multivariate analysis method related to factors predicting AAp showed that gender (male; p=0.034; OR=1.4), WBC (≥10.900; p=0.022; OR=1.5), MPV (≥29.1; p=0.006; OR=1.6), TBil (≥0.61; p=0.034; OR=1.4), CRP (≥0.725; p=0.002; OR=1.7), NLR (≥5.13; p=0.034; OR=1.5), PNR (<24.04; p=0.001; OR=1.9) and US findings (AAp+; p<0.001; OR=2.9) were independent factors for predicting AAp. Multivariate analysis method related to factors predicting appendiceal perforation showed that age (≥32 years; p<0.001; OR=2.5), TBil (≥0.67; p=0.046; OR=1.5), CRP (≥3.75; p<0.001; OR=3.0) and NLR (≥5.69; p=0.006; OR=1.8) were independent factors for predicting perforated AAp. We believe that predicting both AAp and perforation will help the clinician evaluate patients who applied to the emergency unit with presumed diagnosis AAp. This approach will also contribute to reducing the negative appendectomy and perforation rates.

The role of complete blood count parameters in diagnosing acute appendicitis and measuring the severity of inflammation.

The diagnosis and severity of acute appendicitis (AA) are still challenging despite all the improvements in diagnosis and treatment. This study aimed to evaluate the efficacy of complete blood count (CBC) parameters in diagnosing AA and measuring severity. Data of 521 patients were reviewed retrospectively. Fifty-three patients with CBC results influenced by various reasons were excluded from the study. Age, gender, length of stay, CBC parameters, and histopathological results were examined. The study included 468 patients: 90 patients with a preliminary diagnosis of AA, not undergoing surgery but receiving medical treatment (Group I), 227 patients with uncomplicated appendicitis (Group II), and 151 patients with complicated appendicitis (Group III). Of the patients, 279 were male (59.6%) and 189 were female (40.4%). The mean age was 33.37±13.05 years. Groups I and III had the lowest and highest white blood cell (WBC), neutrophil, and neutrophil-to-lymphocyte ratio (NLR), respectively. There was a statistically significant difference between the groups (p<0.05). The highest and lowest mean platelet volume (MPV) values were in Groups II and III, respectively. There was no statistically significant difference between the groups (p>0.05). AA is the most common cause of abdominal surgery. The CBC is a cost-effective and easily-accessible test with acceptable diagnostic accuracy. It provides fast results and can be used in the diagnosis of appendicitis. Neutrophil, WBC, and NLR are helpful and useful parameters for physical examination and other diagnostic methods in diagnosing AA and measuring severity. However, the use of MPV is not recommended as it has a low diagnostic rate and contradictory results.

Acute appendicitis in pregnancy: 50 case series, maternal and neonatal outcomes.

During pregnancy, the most common indication for non-obstetric surgery in acute abdomen is appendicitis. In pregnancy, appendicitis may be confused with pregnancy-related pathologies and may cause a delay in diagnosis or unnecessary surgery. The present study aims to evaluate the maternal and neonatal outcomes of patients undergoing appendectomy during pregnancy. This study was designed retrospectively between 2011-2017. Appendicitis detection rates, admission and laboratory features, operation results and obstetric results were evaluated in pregnant women who underwent surgery for a preliminary diagnosis of acute appendicitis. The findings showed that 2593 patients underwent an appendectomy, 1154 of them were women and 50 of them were pregnant. Negative laparotomy was detected in 12 (16%) patients. Six (12%) of these 50 patients had a laparoscopic appendectomy and 44 (88%) had an appendectomy with laparotomy. The mean time to operation after admission to hospital was 10.5±11 hours. No maternal mortality was observed. Preterm labor occurred in four (8%) patients. Two patients (4%) were in the second trimester and two patients (4%) were in the third trimester. Two (4%) newborns born in the second trimester died postpartum. One of these newborns had multiple anomalies. Appendectomy was not characterized by an increased risk of perinatal mortality. Delay in the diagnosis and surgery of acute appendicitis during pregnancy may increase the risk of perinatal mortality and should not be delayed in diagnosis and surgery in pregnancy.

Torsion of the greater omentum

The medical records of the patients hospitalized in the surgical department and urgently operated for an acute abdominal greater omentum torsion over the past 10 years were retrospectively analyzed. Only two cases that was happened over the past three years and was not related were detected. Both young patients were delivered urgently to the hospital on‑duty surgical department of the city with a clinic of acute abdominal surgical pathology. Both patients underwent the full range of necessary laboratory and instrumental examinations. Patients were repeatedly examined by the on‑duty team consisting of three surgeons with significantly experience. The similarity with the clinical picture of acute appendicitis determined next treatment tactics. The type‑specificity of these patients was determined by the fuzziness of appendicular symptoms during physical examination. The increase in some manifestations of clinical symptoms led to the preliminary diagnosis of acute appendicitis. Both patients were operated on urgently after preoperative preparation. In the operating room, with a thorough revision, the secondary torsion of the greater omentum is visualized. Photofixation and measurement of the resected sections of the omentum were taken. Surgical experience, physical and additional examination methods do not provide clear reliable information about the presence of torsion of the greater omentum. Ultrasound examination of torsion of the greater omentum makes it possible only to determine the «thickened appendix» or infiltration in the abdominal cavity, but it is difficult to determine its components and genesis. When the torsion of the greater omentum is determined, a revision of the abdominal organs should be carried out to exclude the surgical pathology of the appendix, small intestine, cecum and pelvic organs.

The role of abdominal radiography in the diagnosis of acute appendicitis: Is it important?

Aim: Most of the patients presenting to the emergency department with an preliminary diagnosis of acute appendicitis (AA) are undergoing standing plain abdominal radiography (SPAR), but SPAR's contribution to the diagnosis of AA is being questioned today. The aim of our study is to evaluate the importance of SPAR in the diagnosis of AA to elucidate this controversial issue. Material and Methods: We evaluated preoperative SPAR findings and pathology results of patients who were operated with the diagnosis of AA between 2014 and 2017 at General Surgery Department of Ordu University Training and Research Hospital. The relationship between the presence/absence of the SPAR findings and the diagnosis of AA were analyzed. Results: 140 (77.8%) of 180 patients who were operated for suspicion of AA underwent SPAR. Of the 105 patients with SPAR findings, 90 (85.7%) had AA and 15 (14.3%) were no. No findings were found in the 35 of patients who underwent SPAR, 25 (71.4%) had AA and 10 (28.6%) did not. There was no statistically significant difference in the diagnosis of AA in patients with and without SPAR findings (p = 0.098). Of the 140 patients undergoing SPAR, 115 (82.1%) had AA, and 25 (17.9%) were no. Of the 40 patients without SPAR, 27 (67.5%) had AA and 13 (32.5%) did not. Whether or not SPAR was performed did not affect the diagnosis of AA (p = 0.07). Conclusion: SPAR rarely helps in diagnosis of AA. SPAR should not be routinely taken to every patient considered AA. If there is another cause of acute abdomen other than AA as a pre-diagnosis in the physician's mind, SPAR may be taken because it is cheap, accessible and easily interpretable.

Редкая форма кишечной инвагинации у ребенка

Introduction. Intestinal intussusception is the most common type of non-congenital intestinal obstruction and one of the most common nosologies in emergency pediatric surgery. This disease occurs mainly in children of the first year of life and is extremely rare in older age. In children over 3 years of age, intussusception usually has leading points in the form of organic causes: diverticulum, doubling of the intestinal tube, polyps, tumors and others. Material and methods. A child of 7 years old, entered the department of pediatric surgery with acute abdominal pain syndrome, repeated vomiting, the duration of the disease is about 20 hours. The child was operated on urgently basis with a preliminary diagnosis of acute appendicitis. Results. Intraoperative ileocecal invagination with necrosis of the ileum was detected, about which a resection with an anastomosis of the intestine was performed. Histological examination of a remote small intestine revealed the presence of Peutz-Jeghers polyps. After discharge from the surgical department, the child was sent under the supervision of an oncologist and a gastroenterologist. Conclusion This clinical case demonstrates one of the possible causes of intestinal invagination in children older than 1 year. Peutze - Jeghers syndrome is an autosomal dominant condition defined by the development of characteristic polyps throughout the gastrointestinal tract and mucocutaneous pigmentation. Invagination of the intestine is one of the frequent complications of this disease and occurs, as a rule, in older children.

The diagnostic value of serum urokinase-type plasminogen activator receptor in acute appendicitis.

To measure serum uPAR levels in patients operated with a preliminary diagnosis of acute appendicitis (AA) and to investigate whether these parameters can be used as a biochemical marker in the diagnosis of AA. Patients aged 18 or over, presenting to the emergency department between May and December 2018 and operated with a diagnosis of AA were enrolled. This study included 84 patients with surgical pathology results compatible with AA (Group A), 26 patients with surgical pathology results were not compatible with AA (Group B) and 55 healthy control groups. Serum uPAR levels were measured from venous blood samples taken at admission. Mean uPAR levels were 4.53±3.47 ng/mL in the Group A, 1.13±1.63 ng/mL in the Group B and 0.80±1.21 ng/mL in the control group. Serum uPAR levels differed statistically significantly from Group A in Group B and the control group, (p<0.05). uPAR was found to be significantly higher in the AA patients compared to the control group and patients with surgically determined non-AA pathologies. uPAR can be used as an aid in the diagnosis of acute appendicitis.

Reliability of ultrasonography and the Alvarado scoring system in acute appendicitis.

Yazar AS, Erdoğan S, Şahin C, Güven Ş. Reliability of ultrasonography and the Alvarado scoring system in acute appendicitis. Turk J Pediatr 2018; 60: 173-179. In this study, we aimed to evaluate the diagnostic performance of ultrasonography, the Alvarado score, mean platelet volume and C-reactive protein in the diagnosis of acute appendicitis. Patients admitted to the pediatric emergency department with abdominal pain who were operated on with a preliminary diagnosis of acute appendicitis were evaluated. The patients who had acute appendicitis diagnosis in the histopathological assessment were considered as the Appendicitis (App) Group, while patients who did not have acute appendicitis according to histopathology were considered as the Non-app Group. Of 200 patients assessed in the study, 137 (68.5%) were male and 63 (31.5%) were female. Of the patients operated on; 170 (85%) had acute appendicitis, while the pathological results of 30 (15%) were not consistent with acute appendicitis. The Alvarado score of the patients in App Group was significantly higher than those in Non-app Group (p=0.001). The sensitivity and specificity of the Alvarado score and ultrasonography were 60%, 81.18% and respectively, for the diagnosis of appendicitis. There were no significant differences (p > 0.05) in terms of average white blood cell, absolute neutrophil count, platelet count, mean platelet volume and C-reactive protein between the two groups. According to our study the use of Alvarado Scoring System with ultrasonography is more effective and accurative than ultrasonography performing alone. We recommend performing ultrasonography on patients with right lower quadrant pain and suspected appendicitis admitted to the emergency department and to operate on patients with a ultrasonography-supported appendicitis diagnosis and an Alvarado score of 7 and above. Patients with an appendicitis diagnosis not supported by ultrasonography and an Alvarado score lower than 7 should be closely monitored.

The Alvarado scoring system in acute appendicitis: A 6-month cross-sectional study to evaluate its reliability in reducing the rate of negative appendicectomy at Queen’s Hospital, Burton

Introduction Globally, acute appendicitis is the most common paediatric intra-abdominal surgical emergency. The variations at presentation and the lack of a single reliable test to aid diagnosis may pose challenges to experienced surgeons. There are many scoring systems employed by surgeons to reduce the percentage of negative appendicectomies. One such example is the Alvarado system. The aim of our study was to evaluate the usefulness of the Alvarado scoring system in reducing the percentage of negative appendicectomies at Queen’s Hospital, a small district general hospital in England. Case description A 6-month cross-sectional study was carried out. Patients who were 16 years old or younger with a preliminary diagnosis of acute appendicitis were included in the study and their Alvarado score calculated. On the basis of their individual Alvarado score, they were placed in one of two groups: Group A (Alvarado score Results and Conclusions 26 patients (21 males, 5 females) were included in the study. They comprised 9 patients in Group A (34.6%) and 17 patients in Group B (65.4%). The largest age group was represented by 10-15 year olds (n=16, 61.5%). The symptoms at presentation included right iliac fossa pain (92.3%), nausea or vomiting (76.9%) and anorexia (73.1%). Clinical examination revealed tenderness in the right iliac fossa in all patients (100%), rebound tenderness in 16 cases (61.5%) and elevated temperature in 3 cases (11.5%). Laboratory analysis showed raised total leukocyte count in 12 cases (46.2%) with neutrophilia in 10 cases (38.5%). Of the 26 cases, 84.6% (n=22) were confirmed to have inflamed appendix by the surgeon performing the appendicectomy at the time of surgery. However, final diagnosis of inflamed appendix based on histopathology reports were confirmed in 19 cases (73.1%). The overall negative appendicectomy rate was therefore 26.9% (7 cases). The rate of negative appendicectomies in males and females were 15.4% and 11.5% respectively. The negative appendicectomy rate in Group A and B were 33.3% and 17.6% respectively. Sensitivity and specificity of Alvarado score in our study were 82% and 100% respectively. Take home message Regarding, the reliability of the Alvarado scoring system, our recommendations are: (1) false negatives are few especially in high Alvarado scores (9 or greater); (2) further investigations may be employed in low scores ( (3) the Alvarado scoring system should be used to supplement the diagnostic accuracy of acute appendicitis. It does not however replace the experience and expertise of the surgeon. Surgery were performed in all the cases, along with conservative treatment pre-and post-surgery. Final diagnosis using histopathology reports was confirmed in 19 cases (73.1%) The overall rate of negative appendicectomy was therefore 26.9%. Sensitivity and positive predicted value of the Alvarado score were 82% and 100% respectively.

Diagnostic Value of Plasma Pentraxin-3 in Acute Appendicitis

ABSTRACTPurpose: To measure serum PTX3 levels in patients admitted with right lower quadrant pain to emergency department and to investigate whether this parameter will be helpful for the diagnosis of acute appendicitis.Materials and methods: This study was conducted with a group of 89 patients over 17 years of age who were admitted with the complaint of right lower quadrant pain to ED and had a preliminary diagnosis of acute appendicitis clinically and the control group of 31 healthy volunteers in a tertiary university hospital for 3 months.Results: Median PTX3 levels were 3.28 (1.08-30.24) ng/mL in the acute appendicitis groups and 0.97 (0.34-2.62) ng/mL in the control group. A significant difference was observed between acute appendicitis groups and the control group (p < 0.05).Conclusion: PTX3 was found to be significantly higher in patient with acute appendicitis compared to the control group and the patients with non-specific abdominal pain. PTX3 can be used as an aid in the diagnosis of acute appendicitis.

The Alvarado score in acute appendicitis: A 3-year audit to evaluate the usefulness in predicting negative appendicectomies in ≤16 s at QHBFT

ObjectiveTo evaluate the diagnostic accuracy of the Alvarado score in reducing the rate of negative appendicectomy at Queen’s Hospital, a small district general hospital in England. MethodologyThe retrospective, analytical study included all children who were ≤16 years old with a preliminary diagnosis of acute appendicitis undergoing appendicectomy subsequently. Children with other causes of acute abdominal pain were excluded from the study. A total of 118 patients were included. Based on their calculated Alvarado scores, they were stratified into two groups: Group A (Alvarado score <6) and Group B (Alvarado score ≥6). Alvarado scores were compared with the histopathology reports, the gold standard for diagnosing acute appendicitis. The data gathered was then subjected to statistical analysis to measure our objective. ResultsOut of the 118 patients (85 males, 33 females), 46 belonged to Group A and 72 to Group B.Final diagnosis of acute appendicitis from histopathology reports was confirmed in 94 cases (79.6%). The overall sensitivity and positive predictive value of Alvarado score for acute appendicitis were 92% and 94% respectively. The area under the ROC curve was 0.9 indicating a highly accurate test.The sensitivity was only slightly higher for males with a score of <6 than females (94.9% vs. 89.5%, p < 0.05).However, for scores ≥6, sensitivity among males was significantly higher than females (79% vs. 62.6%; p < 0.05).A multivariate analysis revealed that anorexia, right iliac fossa tenderness and rebound tenderness are significantly correlated with a correct diagnosis of acute appendicitis (p = 0.025, 0.037 and 0.026 respectively). ConclusionThe presence of a high Alvarado score (≥6) is highly predictive of acute appendicitis.In women of childbearing age and Alvarado scores of <6, other pathologies that mimic appendicitis must be considered. An US scan of abdomen and pelvis should be considered in a woman of child-bearing age before proceeding to a surgical intervention.

Carcinoid tumor of appendix; retrospective review of 1800 appendectomy patients

Malignant tumors of the appendix are rare and the histopathological diagnosis can often be made in the postoperative period. The clinical records of 1800 patients who underwent surgery in emergency conditions with a preliminary diagnosis of acute appendicitis were reviewed retrospectively. Carcinoid tumor was detected in 7 patients (0.38%) on histopathological examination. Of these patients, 4 were male (57.1%), 3 were female (42.9) and the mean age was found to be 36 (22-49). Appendiceal carcinoid tumors are tumors with a good prognosis. Even though their prognosis is good, close monitoring of the patients is recommended due to the likelihood of the detection of a proportion (13-33%) of synchronous and/or metachronous colorectal cancer in the literature.

Is diagnostic accuracy of Alvarado scoring feasible in acute surgery for management of acute appendicitis?

Aim: To evaluate the usefulness and feasibility of the Alvarado scoring system in acute surgery in reducing the percentage of negative appendicectomy in our institute.Materials and Methods: A prospective study was conducted, comprising 100 patients, admitted to department of Surgery in Maharishi Markendeshwar Institute of Medical sciences &amp; Research (M.M.I.M.S.R), Mullana, Ambala, India during the period October 2012 to July 2014 with a preliminary diagnosis of acute appendicitis. Patients of both sexes and all age groups were included in the study and their Alvarado scores calculated, on the basis of which patients were divided into three groups: group1 (alv. Score &gt;7) , group 2 (alv. score 5-6), group 3 (alv. Score &lt;4). The signs, symptoms, laboratory values, surgical interventions, and pathology reports of each patient were evaluated. Diagnosis was confirmed by histopathological examination. Sensitivity, specificity, and positive and negative predictive values of scoring system were calculated. Results: Out of 100 cases (82 males, 18 females), 76 Patients belonged to be in group1 (76%), 20 patients were in group 2 (20%) and 4 patients were in group 3 (4%). All 100 patients were operated, of which 86 patients found to have inflamed appendix (86%). 82 (82%) of operated patients were male and 18 (18%) were females. Out of 82 of operated males, 64 were having score &gt; 7, 8 were having score 5-6 and 1 had score &lt;4. Out of 18 operated females, 6 were having score &gt; 7, 4 were having score 5-6, and 2 females had scoring &lt;4. Negative appendectomy rate in our study was 14% which showed that Alvarado score helped in making diagnosis of acute appendicitis; thus reducing negative appendicectomy. Sensitivity and specificity of the Alvarado scoring system were found to be 83.7% and 71% respectively. Positive and negative predictive values were 94.7% and 83.3% respectively. Conclusion: Alvarado score can be used effectively in acute surgery in our setup to reduce the incidence of negative appendectomies in both male and females. It can be applied easily for acute surgery even by junior surgical colleagues with limited diagnostic facilities available to them.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.166-171

The comparison of the effectiveness of tomography and Alvarado scoring system in patients who underwent surgery with the diagnosis of appendicitis.

The aim of this study is to compare the effectiveness of computed tomography and Alvarado scoring system in the diagnosis of acute appendicitis in patients who underwent appendectomy with the preliminary diagnosis of acute appendicitis. One hundred and one patients who underwent appendectomy with the diagnosis of acute appendicitis between January and December 2011 were included in the study. Alvarado scores were calculated, and abdominal tomography scans were obtained for each patient before surgery. Patients with Alvarado score ≥7 were considered to have appendicitis while patients with a score <7 were considered not to have appendicitis. Patients were classified into two groups based on the presence of appendicitis findings on abdominal tomography. Histopathological examination of the appendices was performed following appendectomy. All patients were classified into groups according to pathology results, Alvarado score and tomography findings. The effectiveness of Alvarado score and tomography were compared using the McNemar test. Sixty patients (59.4%) were male and 41 (40.6%) were female, with a mean age of 32 years (5-85 years). The rate of negative appendectomy was 3.9%. In 78 patients (77.3%) the Alvarado score was ≥7, while 23 patients (22.7%) had Alvarado scores <7. The presence of appendicitis was determined by histopathology in 22 out of 23 patients whose Alvarado score was <7. Tomography indicated appendicitis in 97 patients (95.9%) whereas four patients (4.1%) exhibited no signs of appendicitis by tomography. However, histopathological evaluation indicated the presence of appendicitis in those four patients as well. The study results imply that tomography is a more effective means of diagnosing acute appendicitis as compared to the Alvarado scoring system.

Comparison of intracorporeal knotting and endoloop for stump closure in laparoscopic appendectomy.

Several appendiceal stump closure tecniques such as intracorporoeal-knotting, endoloop, stapler and clips are used during laparoscopic appendectomy. This study aimed to compare intracorporoeal-knotting and endoloop tecniques used to close appendiceal stump in laparoscopic appendectomy. This study included patients who underwent laparoscopic appendectomy with preliminary diagnosis of acute appendicitis in General Surgery Department of Adana Numune Training and Research Hospital between June 2009 and July 2013. The demographics, appendiceal stump closure tecniques, operation time, complications, and length of hospital stays of the patients were compared. A total of one hundred and twenty-six patients underwent laparoscopic appendectomy (Female: 81, Male: 45). Intracorporeal-knotting (Group 1) was performed in sixty-five patients; whereas, endoloop (Group 2) was performed in sixty-one patients in order to close appendiceal stump. The operation time was longer in Group 1 compared to Group 2 (62.0±10.67 min., 56.80±11.94 min., p=0.01). The length of hospital stays were nonsignificant between the groups. Four patients were complicated by superficial surgical site infection in both groups. In the present study, the operation time was found to be longer for intracorporeal knotting tecnique compared to endoloop tecnique; however, there was no significant difference regarding the length of hospital stay and complications. Performing intracorporeal-knotting technique is suggested since it is cheaper than endoloops and it may also improve hand manipulations of the surgeons who intend to advanced laparoscopy.