Provisional Diagnosis Of Acute Appendicitis Research Articles

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

COMPARISON OF ULTRASOUND AND THE ALVARADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS : A PROSPECTIVE COMPARATIVE STUDY IN A TERTIARY CARE CENTRE IN WESTERN MAHARASHTRA

Background :Acute appendicitis is one of the most common surgical emergencies with a lifetime prevalence of approximately 1 in 7. The Alvarado scoring system and ultrasonography play a definite role in diagnosis of acute appendicitis, because of the easy availability, cost effectiveness and being radiation free. According to the analysis, the percentage of Appendicectomies done for a normal appendix mistaken to be Acute Appendicitis was found to be as high as 20%.The following study compares the accuracy of the Alvorado scoring system and Ultrasonography in the diagnosis of Acute appendicitis and examines the value of using both modalities together. Materials and Methods :In this study 100 patients were included with provisional diagnosis of acute appendicitis and admitted and operated in the Department of General Surgery, MGM Medical College, Navi Mumbai between January 2021 to November 2022. Alvarado score was applied and ultra sound abdomen was done pre operatively. The decision for surgery was made independent of the score and ultra sound finding. Diagnosis of patients who underwent appendicectomy was confirmed by histopathology report. Results :In the present study, 100 cases were provisionally diagnosed of having acute appendicitis and were operated during the study period.Itwas seen that 95.52% of patients who were thought to be positive by Alvarado score >=7 usually had appendicitis by histopathology where as 4.08% of the patients were normal by histopathological examination. This accounted for 47.96% and 33.33% of the total patients respectively. From this the sensitivity of the Alvarado score is calculated to be 47.96%. Ultrasound alone showed a PPV of 67% and a NPV of 66.7%. Conclusion :In our study, Alvarado score had better sensitivity than ultrasonography. Alvarado score has a high diagnostic value (97.7%). USG has role in ruling out normal appendix and other pathology, with a specificity of 66.67% When we diagnose acute appendicitis based on the individual results of Alvarado score and USG, we get a statistically significant value. Hence as a conclusion of this study, alvaradoscore and USG together could be applied in the diagnosis of acute appendicitis for better outcomes and decision making.

Comparison of Alvarado score, appendicitis inflammatory response score (AIR) and Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score in predicting acute appendicitis

IntroductionAcute Appendicitis is the most common surgical emergency encountered in emergency departments. To prevent the rate of negative appendectomies, different systems i.e. Alvarado score and Appendicitis Inflammatory Response Score (AIR) scores were used, but their diagnostic accuracy in Asian population is questionable. Raja Isteri Pengiran Anak Saleha (RIPASA) score has showed promising results in the recent literature. The purpose of this study is to compare the efficacy of Alvarado, AIR and RIPASA scores in the diagnosis of acute appendicitis. MethodsAlvarado, AIR and RIPASA scores were prospectively applied to 132 included patients that were admitted with provisional diagnosis of acute appendicitis and then their surgery was performed in General Surgery Unit, Hayatabad Medical Complex Peshawar, Pakistan from 1st January 2022 to 31st July 2022. Final diagnosis was confirmed by histopathology report and scores were correlated with final report. Cut off value of score >7, >5 and >7.5 were set for Alvarado, AIR and RIPASA score, respectively according to previous literature. Statistics analysis was done for all 3 scoring systems on SPSS version 23. ResultsOf 132 patients, there were n = 79(59.8%) males and n = 53(40.2%) females. Mean age was 24 years (SD ± 11.6) with youngest patient of 9 years and oldest one was 70 years old. Negative Appendectomy rate was 8.3%(n = 11). RIPASA score was superior to AIR and Alvarado score in Sensitivity, NLR, Accuracy and Area under the Curve. AIR score performed better in specificity, NPV, PLR compared to RIPASA and Alvarado score. ConclusionRIPASA score is an overall better scoring system in diagnosing acute appendicitis in compared to Alvarado and AIR score.

MICROBIOLOGICAL PROFILE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF INTRALUMINAL SWABS IN ACUTE APPENDICITIS

Background: Acute appendicitis is one of the most common abdominal surgical emergencies worldwide and represents an important burden on modern health systems. The cause of the development of sepsis post appendicectomy is multifactorial. A better knowledge of bacteriology and high-risk factors for septic complications in patients with appendicitis will allow a better selection of empirical and therapeutic antibiotic regimens. Materials and methods: This was a prospective study. A total of 111 patients admitted to Dept. of General Surgery, M.K.C.G. Medical College & Hospital with a provisional diagnosis of acute appendicitis from July 2018 to June 2020 were included in the study. All patients received ceftriaxone, ofloxacin and metronidazole as empirical antibiotics in the perioperative period. The intraluminal swab of the excised appendix was sent for microbiological study, and the excised appendix was sent for histopathological study. Results: Bacteria were isolated from 73 out of 111 samples sent for culture (65.76%). The most common organism cultured was Escherichia coli which accounted for 38 isolates (50%). The perforation rate with Pseudomonas aeruginosa positive culture was highest (45.45%), followed by E. coli (21.05%). A high wound infection rate was associated with E. coli (44.44%), followed by P. aeruginosa (33.33%). Amongst patients who developed post-operative wound infection, 66.67% and 46.67% were resistant to ceftriaxone and ofloxacin, respectively. 100% of patients with intra- peritoneal abscesses were resistant to both empirical antibiotics. Conclusion: E. coli and P. aeruginosa were the commonest organisms associated with complicated appendicitis and postoperative sepsis; they were frequently not covered by empirical antibiotics. Change of empirical antibiotics to a higher spectrum is paramount in such cases and may reduce the incidence of both morbidity and mortality.

Appendicitis Inflammatory Response Score in Acute Appendicitis: A Study at a Tertiary Care Center in North India.

Appendicitis is a common cause of acute abdominal pain. The diagnosis is eminently clinical and the cause is surgically correctable. However, a decision of surgery based on the clinical presentation only has a 15%-30% chance of the removal of a normal appendix. Thus, the diagnosis involves a corroboration of clinical, laboratory, and radiological findings. Appendicitis scoring systems can be considered to expedite the diagnostic and decision-making process. The present study was conducted to study the efficacy of Appendicitis Inflammatory Response (AIR) score in the diagnosis of acute appendicitis and its correlation with the histopathological findings. A cross-sectional study was conducted at a tertiary care center in North India comprising patients who presented to the surgery department with a provisional diagnosis of acute appendicitis and required appendectomy. Appendicitis was histopathologically proven in 54 patients. Patients with an AIR score ≥5 were 2.18 times more likely to have appendicitis. The probability of having appendicitis with AIR score ≥5 was 92.16% (positive predictive value). The diagnostic accuracy of AIR score was 82.81%. AIR score has a high sensitivity and positive predictive value in the diagnosis of acute appendicitis. It is a quick and convenient system for clinical evaluation of patients in primary care or peripheral hospitals where advanced facilities such as USG scan or CT scan are not available all the time. The application of this scoring system definitely improves diagnostic accuracy and reduces negative appendectomy rate.

PREOPERATIVE NEUTROPHIL TO LYMPHOCYTE RATIO AS A PREDICTOR OF THE SEVERITY OF ACUTE APPENDICITIS

Background: Neutrophil to lymphocyte ratio (NLR) is one of the tools to differentiate compli­cated and uncomplicated acute appendicitis (AA) preoperatively. However there is a consid­erable difference in the cutoff values of NLR in different studies. This study aimed to establish a cutoff value of NLR to distinguish complicated AA from uncomplicated AA preoperatively at our center. Methods: This was a prospective observational study conducted over 2 years from January 2017 to December 2019 in the department of surgery, Chitwan Medical College Bharatpur. Patients with a provisional diagnosis of AA and undergoing appendectomy were included in the study. The difference in NLR between the two groups was compared by Mann-Whitney U-test. The predictive ability of NLR was estimated by the receiver operating characteristic (ROC) curve analysis. Results: One hundred eighty-eight patients were included in the study, 112 patients were males and 76 were females. Among them, 29.2% (n=55) were complicated AA. Median NLR was signifi­cantly higher in the complicated AA group compared to the uncomplicated group (6.90 vs 4.27, P <0.001). On ROC analysis, the predictive ability of NLR for complicated AA was acceptable (AUC: 0.705, p <0.001). The optimal cut-off value of NLR to predict complicated acute appendicitis was 4.77, with sensitivity and specificity 74.5% and 65.4% respectively. Conclusions: NLR ≥ 4.77 can be a useful adjunct in predicting complicated AA preoperatively. But because of poor sensitivity and specificity, a lower value does not exclude complicated AA. and therefore other biochemical and radiological parameters have to be taken into consideration.

Evaluation of Alvarado Score in the Diagnosis of Acute Appendicitis

Abstract Background: Acute Appendicitis (AA) remains the most frequent abdominal surgical emergency in the developed world. Failure to make an early diagnosis is a primary reason for the persistent rate of morbidity and mortality. Decision making in cases of acute appendicitis may be a problematic experience in developing countries where the facilities for investigations lack, especially in rural and semi-rural areas. Alvarado Score (AS) may be used as a guide. Aim of Study: To evaluate the effectiveness of Alvarado Score in diagnosing acute appendicitis by correlating it with the operative findings, and the pathologic findings if it is feasible. Also, to know the specificity and sensitivity of Alvarado Score as a diagnostic tool of acute appendicitis in both genders and all age groups, so we can apply it to all patients suspected to have acute appendicitis. To save time and money by diagnosing Acute Appendicitis with the help of Alvarado Score and using it as a guide in requesting a CT Abdomen for suspicious appendicitis. So, we can eventually reduce the number of negative appendices or complications of undiagnosed appendicitis. Patients and Methods: The study was conducted on 50 patients complaining of lower abdominal pain with a provi-sional diagnosis of acute appendicitis, selected non-randomly, in the Emergency Department of Harpur Memorial Hospital in Menof City, Menofeya Governorate-Egypt. Patients were assessed pre-operatively by the Alvarado scale. Post-operative histological examination of removed specimens was done. Results: The results showed that 60% of the patients were males. The mean age was 27.54, range (9-62) years old. 100% of cases had Right Lower Quadrant tenderness (RLQ) as well as Rebound tenderness, followed by; anorexia in (96%) of cases. The migration of pain to the right lower quadrant was present in (68%) of cases. Conclusion: We concluded that in our local setting, efficacy (sensitivity, specificity, and diagnostic odds ratio) of Alvarado Score, using a conventional cut off value of 7 for high-risk group, in the diagnosis of Acute Appendicitis is a good initial evaluation of patients with acute lower abdominal pain. Also, it is a cheap and quick tool to apply in Emergency Departments to rule our acute appendicitis.

Does CT Reduce the Rate of Negative Laparoscopies for Acute Appendicitis? A Single-Center Retrospective Study.

In surgical practice, surgeons request CT scans to rule out acute appendicitis, even in young patients. We aimed to assess the feasibility of using a CT scan to reduce the rate of negative laparoscopies in patients younger than 40 with equivocal signs of acute appendicitis.Therefore, we conducted a retrospective observational study on the patients admitted with a provisional diagnosis of acute appendicitis. Patients younger than 40 and with the Alvarado score between 3 and 6 were included. These were divided into two groups: those who had or did not have a CT scan. Each group was further subdivided into patients that had a laparoscopy and those that did not.Out of 204 patients included in the study, 16% were included in the CT group, and 84% in the non-CT group. 71.9% of the patients that underwent a CT scan had appendicitis and underwent an appendectomy. Five patients with a normal CT scan had appendectomy due to persistent signs of acute appendicitis. The histopathology of the 23 patients with positive CT was positive, and 3 of the 5 patients with negative CT that underwent appendectomy had positive histology results. The negative appendectomy rate for patients that had preoperative CT is 7.14% compared to 32.4% in patients without preoperative CT.The rate of negative laparoscopy in patients younger than 40 years old that undergo preoperative CT is significantly lower with a p-value of .00667.

Comparative study between modified Alvarado score and abdominal ultrasound in the diagnosis of acute appendicitis

Aim & Objective: To compare the accuracy of modified Alvarado score and ultrasonography in the diagnosis of acute appendicitis to reduce the morbity and mortality from appendicitis and also reduce the negative appendicectomy rates Methodology: This study was undertaken in 100 patients with a provisional diagnosis of acute appendicitis getting operated in Prathima Institute of Medical Sciences, Karimnagar from November 2016 to October 2018. Modified Alvarado score and USG findings were applied in the preliminary diagnosis, which was confirmed by intra operative and histopathological findings. Results: Fifty five patients were females and forty five were males. There was no statistical significance in the male to female ratio. The highest incidence (37%) was found in the age group of 21-30 and the lowest (4% each) was seen in the age group of 51-60 & 61 & above respectively. Ninety nine patients presented with anorexia and tender RIF. Ninety eight patients had migratory RIF pain. Nausea & vomiting, rebound tenderness, and leucocytosis were seen in 58, 53 and 39 patients respectively. Only 27 patients had elevated temperature. Forty three patients had a score of >7 out of which 42 had appendicitis and 1 was normal on histopathological examination which contributed to 97.7% and 2.3% of the patients respectively. Sensitivity, specificity and accuracy of MAS was 44.6%, 83.3%, 47% respectively. Sixty one patients were found to have appendicitis by USG out of which 60 had appendicitis and 1 was normal on histopathological examination, with a sensitivity of 63.8% and a specificity of 83.3% & accuracy 65%. Ninety four patients were diagnosed to have appendicitis by histopathological examination and 6 were reported to be normal. Accuracy of ultrasound to diagnose acute appendicitis was 65% and MAS was 47%.

Streptococcus pneumoniae primary peritonitis mimicking acute appendicitis in an immunocompetent patient: a case report and review of the literature

IntroductionPrimary peritonitis without an identifiable intra-abdominal source is extremely rare in healthy individuals; it is commonly seen in cases of nephrotic syndrome, cirrhosis and end-stage liver disease, ascites, immunosuppression, and inflamed peritoneum due to pre-existing autoimmune and oncological conditions.Case presentationWe present the case of a 68-year-old Caucasian woman operated on due to acute abdomen with a provisional diagnosis of acute appendicitis. During the operation a small amount of free intra-abdominal fluid was found. Her uterus, ovaries, and fallopian tubes were macroscopically normal. Therefore, with the suspicion of appendicitis, appendectomy was performed. Her blood cultures were negative while peritoneal fluid was positive for capsulated form of Streptococcus pneumoniae. A 30-day follow-up was performed and she was asymptomatic without any sign of infection.DiscussionStreptococcus pneumoniae commonly causes upper respiratory tract infection and cutaneous infections. It very rarely causes gastrointestinal infection and it is very rarely responsible for primary peritonitis and septic shock syndrome.ConclusionPneumococcal peritonitis has a rare occurrence and represents a clinical challenge because of its subtle and non-specific clinical findings. The interest in our case lays in the relatively rare diagnosis of primary peritonitis mimicking acute appendicitis.

Role and Incidence of Parasitic Infection in Adult Egyptian Patients with Acute Appendicitis

Background: Appendicitis is the most important acute surgical condition of the abdomen, and appendectomy constitutes one of the most common surgical operations worldwide. Many factors can cause appendicitis but the intestinal parasitic infections are one of the most important causes. Objective: The present study aimed to evaluate and detect the role and incidence of various parasitic infections in appendectomy specimens from Egyptian adult patients with acute appendicitis attending the General Surgery Emergency room at Al-Azhar University Hospitals, Cairo, Egypt (Al-Hussein and Sayed Galal Hospitals). Patients and methods: The present study was carried out on 200 patients undergoing appendectomy with a provisional diagnosis of acute appendicitis during the period from December 2015 to November 2016. The removed appendices were fixed in 10% buffered formalin, sectioned, stained with H&E and examined for histopathological changes and presence of parasites. Stool examination was also done by direct smear, formol ether concentration techniques as well as CBC examination for all patients. Results: Stool examination revealed 120 (60%) out of the total 200 appendectomy patients were positive for parasitic infections, while CBC examination revealed leucocytosis among 167 (83.5%), and eosinophilia in 40 (20%) as well as anemia in 43 (21.5%) in all the studied patients. Histopathological examination revealed parasitic infections in 6 (3%) of appendectomy specimens. The presence of E. vermicularis worms and their eggs as well as Schistosoma ovawere observed in 4 (2%) and 2 (1%) of cases respectively. Features of acute suppurative appendicitis were observed in 143 (71.5%) of cases, of which, 98(49%) cases had luminal obstruction by fecalith and 45 (22.5%) showed patent lumen. Non suppurative appendicitis were presented in 57 cases (28.5%) which included lymphoid hyperplasia in 21 cases (10.5%) and neuronal hyperplasia in 6 cases (3%) as well as granulomatous appendicitis with features consistent with appendiceal Crohn’s disease (CD) in 30 cases (15%). Conclusion: The study concluded that parasitic infections constitute 3% of the surgically removed appendices where Schistosoma eggs and E. vermicularis (adults and eggs) were the parasites recorded. So differential diagnosis of parasitic infections in the etiology of acute appendicitis should be made properly which can save patients from a negative laparotomy, morbidity and even mortality.

Torsed intraabdominal testis mimicking acute appendicitis in a 60 year old male

We present a case of 60-year-old male who came to our emergency room with complaints of severe pain in right lower abdomen. Based on history, clinical examination and investigation, we made a provisional diagnosis of acute appendicitis. We explored the patient and found a torsed intraabdominal testis just below the deep ring. Histopathology of the resected specimen showed gangrenous testis.

Gynaecological Diagnosis in Patients with Provisional Diagnosis of Acute Appendicitis

Gynaecological Diagnosis in Patients with Provisional Diagnosis of Acute Appendicitis

DETERMINATION OF SENSITIVITY AND SPECIFICITY OF ULTRASONOGRAPHY IN ACUTE APPENDICITIS: COMPARISON WITH PER-OPERATIVE FINDINGS AND HISTOPATHOLOGICAL REPORT

Objective: This study was under taken to compare the ultrasonographic findings with pre-operative findings and histo-pathological report and to evaluate the sensitivity, specificity, positive and negative predictive values and accuracy of ultrasonography in the diagnosis of acute appendicitis.Methods: It was a prospective study done in the department of radio-diagnosis, SCBMCH, Cuttack. Patients with provisional diagnosis of acute appendicitis were subjected to ultrasound of abdomen and pelvis. Patients with positive USG findings were followed up for pre-operative findings and histo-pathological results. All the obtained data were tabulated and subjected to statistical analysis.Results: Among the 100 cases studied, 77 cases were proved as acute appendicitis based on surgical and histopathological results. Male to female ratio was 1.5:1. The disease was found to be more prevalent in second and third decade of life. Location of affected appendix was most commonly retro caecal. Mean diameter of the appendix was 8.56 mm. Target sign and non-compressible bowel loop was the most commonly detected ultrasonographic sign and the ultrasonographic sensitivity was 96.1% and specificity was 95.65% in our study.Conclusion: High resolution sonography with graded compression is a very useful diagnostic tool for diagnosis of appendicitis in problematic cases and in women in their reproductive period. It is also helpful in detecting complications of appendicitis and other abdominal diseases that mimic acute appendicitis.

Prospective validation of neutrophil-to-lymphocyte ratio as a diagnostic and management adjunct in acute appendicitis.

No optimal biomarker exists that accurately diagnoses appendicitis or predicts severity, estimates post-operative complications or total length of hospital stay (LOS). To prospectively validate the utility of neutrophil-to-lymphocyte (NLR) ratio in predicting the severity of appendicitis, LOS, and 30-day complication rates. Patients who were admitted with a provisional diagnosis of acute appendicitis over a period of 18months (Oct 2014-April 2016) were included. Patient demographics and blood results were prospectively collected. Details of imaging, operative intervention, severity of appendicitis, length of stay, and 30-days post admission complications were recorded. Recommended cut-off values of NLR and C-reactive protein for severity of appendicitis were determined using receiver operating characteristic analysis (ROC). These cut-off values were compared with C-reactive protein levels. Mann-Whitney test was performed to assess the correlations between LOS and 30-day complications to NLR. Four hundred fifty-three patients were included in the study; 55.2% (n=245) were female with mean patient age of 23years. Two-thirds (n=281, 62.03%) underwent operative management. Histologically, appendicitis was confirmed in 214 (76%) patients. A NLR of >6.36 or CRP of >28 were statistically associated with complicated acute appendicitis, with a median of one extra hospital day (p<0.0001). Mean NLR was statistically higher in patients with post-operative complications (14.42 vs. 7.29 for simple appendicitis group, p<0.001). This confirms previous reports that NLR is a simple, readily available adjunct in predicting severity of appendicitis. Additionally, it can aid delineating severe appendicitis that should proceed to surgery without substantial delay.

Evaluation of modified Alvarado scoring system in diagnosis of acute appendicitis - a prospective study

Background:The most frequently encountered complaint which is a surgical emergency also is pain in abdomen and under this spectrum falls pain of acute appendicitis, which remains very common cause of acute surgical abdomen. The diagnosis may be straightforward or tricky due to variable clinical presentations. Emergency appendectomy is usually done on decision taken by surgeon.Methods: It includes all patients admitted for pain in the right iliac fossa with provisional diagnosis of Acute appendicitis and treated at SAMC PGI, including all patients above the age of 16 years admitted with pain in the right iliac fossa with provisional diagnosis of Acute Appendicitis and excluding those with severe cardiac risk for surgery, associated malignancy or with associated ascites.Results:A total of 95 patients were included in our study out of which 9 patients were diagnosed with different pathology than appendicitis. Out of 86 confirmed with appendicitis 69.76% were male and 30.24% were female. Maximum incidence in adult age group seen in 20-40 years (67%).Incidence after 50 years of age is very less (4.65%)In our study out of 51 modified Alvarado score positive cases, 49 (96%) were histologically positive and 2 (4%) were negative. Whereas among remaining 35 modified Alvarado score negative cases only 20 (57.14%) were histologically positive with a p value &lt;0.0001. Among the 68 ultrasonography positive cases for appendicitis, 65 (95.5%) were also found to have positive features of appendicitis on histopathologically examination and out of them 3 (4.4%) were histologically negative.Conclusions:Acute appendicitis is one of the most common acute abdominal conditions requiring emergency surgery and its diagnosis remains challenging. Thus we finally conclude that incorporation of modified Alvarado scoring system for establishment of diagnosis in cases of suspected acute appendicitis surely provides higher accuracy of diagnosing acute appendicitis and helps in decreasing negative appendectomies.

Evaluation of clinical diagnosis of children with acute appendicitis at Rapareen Teaching Hospital

Background and objectives: Appendicitis is the most common acute surgical emergency of childhood. Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide. Among the reported diagnostic criteria, modified Alvarado score system and ultrasound findings where used to support diagnosis and even exclude complicated cases. The aim of this study was to detect clinical and sonograghic features that distinguish children visited the emergency department with acute simple appendicitis and idntify factors related to complicated cases. Methods: This cross-sectional study included 76 children with the provisional diagnosis of acute appendicitis according to clinical findings attending the Emergency Departement at Rapareen Teaching Hospital in Erbil between January and December 2012. Results: Of 76 patients included in this study, 75 patients (99.7%) had appendicitis whether inflamed (63 patients, 82.9%) or complicated (13 patients, 15.8%) and only one patient had normal operative (non-inflamed appendix) findings. Delay of admission, high temperature at time of presentation, localized tenderness and MASS of ≥ 7 increased the risk of complicated appendicitis as do leukocytosis and positive ultrasound findings. Conclusion: The study shows that use of certain clinical data (like duration of manifestations) with the modified Alvarado score system supported by leukocytosis and positive ultrasound findings in children suspected to have acute appendicitis provides a high degree of diagnostic accuracy of complicated cases rather than simple acute appendicitis

Role of Mean Platelet Volume (MPV) In Diagnosis of Acute Appendicitis

The diagnosis of acute appendicitis still remains an enigma for the surgeon. The Mean Platelet volume is known to be a marker determined from megakaryocytes during platelet production, which is associated with platelet function and activation.The mean platelet volume (MPV) decreases in acute inflammatory conditions like acute appendicitis due to increased consumption and sequestration of platelets in the vascular segments of inflamed bowel. In our study of 213 patients, the MPV was determined and was found to be low ( < 7.6fL) in 176 patients ( 82.6%) out of which 175 patients were having features of acute appendicitis on histopathology. Therefore in a patient with a provisional diagnosis of acute appendicitis, a low MPV (<7.6fL) can be taken into consideration along with total leucocyte count with suspected acute appendicitis.

Perforation of Meckel’s diverticulum by a fish bone presenting as acute appendicitis: a case report

IntroductionMeckel’s diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Most of them are asymptomatic but can rarely present with forms of complications such as bleeding, obstruction, diverticulitis, intussusception and neoplasm. Patients with a perforation of Meckel’s diverticulum by a foreign body are rare and may present with right iliac fossa pain, which mimics acute appendicitis.Case presentationA 64-year-old Greek man presented with an eight-hour history of right iliac fossa pain. On examination, our patient had tenderness in his right iliac fossa. A provisional diagnosis of acute appendicitis was made. He was taken to theatre with the option of an appendicectomy. His appendix was found to have an about normal appearance. An inflamed Meckel’s diverticulum that had been perforated by a fish bone was found to be the cause of the abdominal pain. A Meckel’s diverticulectomy was performed. Our patient made an uneventful recovery and was discharged after two days.ConclusionsComplications of Meckel’s diverticulum can be difficult to diagnose and early recognition and timely operative intervention must occur in order to provide the best outcome for these patients. This is an interesting and unusual case of perforation of Meckel’s diverticulum that highlights the importance of considering Meckel’s diverticulum as a differential diagnosis in every patient presenting with acute abdomen.

An extremely rare appendiceal anomaly: horseshoe appendicitis

Appendiceal anomalies are extremely rare malformations that are usually found in adult populations as an incidental finding. Agenesis and duplication of the appendix have been well documented, but we know of only three reported cases of a horseshoe appendix. A 64-year-old woman admitted to the emergency department. A provisional diagnosis of acute appendicitis was made, and the patient was taken to the operating room. While appendectomy was being performed with a standard approach, the distal tip was seen to communicate with the cecum by another stump, or "horseshoe appendix". The aim of this report is to share our experience with this extraordinary finding.