DIAGNOSTIC ACCURACY OF ULTRASONOGRAPHY IN ACUTE APPENDICITIS
AbstractBackground: The diagnosis of acute appendicitis is mainly clinical and to augment the clinical diagnosis ultrasonography and Computerized Tomographic Scan of the abdomen are also being used to help in diagnosis of the disease; which all carry some inherent limitations. This study was done to establish diagnostic accuracy of Ultrasonography (USG) in acute appendicitis taking histopathology of removed appendix as the gold standard. Methods: This cross-sectional validation study was conducted in Radiology Department, Military Hospital and Combined Military Hospital Rawalpindi from July 2007 to January 2008. Sixty cases of clinically suspected acute appendicitis were selected on non-probability convenience sampling technique. All of them underwent ultrasound evaluation. Diagnostic accuracy of USG was calculated keeping histopathology of the removed appendix as gold standard whenever appendectomy was carried out. Results: Out of 60 patients whose USG of right lower quadrant was performed, 30 patients were correctly diagnosed as having acute appendicitis on USG out of 34 finally diagnosed cases based on histopathology. Similarly we picked 12 normal appendices out of 26 non-appendicitis patients. This showed that US scan has sensitivity of 88%, specificity of 92%, positive predictive value of 94%, negative predictive value of 86%, and overall accuracy of 90%. The most accurate appendiceal finding for appendicitis was a diameter of 7 mm or larger followed by non-compressibility of inflamed appendix. Conclusion: Ultrasonography has high accuracy in diagnosing acute appendicitis and reduces negative appendectomies. Greater than 6-mm diameter of the appendix under compression is the most accurate USG finding with high positive predictive value for the diagnosis of acute appendicitis.Keywords: Ultrasonography, Appendix, Appendicitis, Appendectomy
Iqbal M. Appendicitis: a diagnostic dilemma. Rawal Med J 2005;30:51–2.
Anderson RE, Hugander AP, Ghazi SH, Ravan H, Offenbartl SK, Nystron PO, et al. Diagnostic value of disease history, clinical presentation and inflammatory parameters of appendicitis. World J Surg 1999;23:133–40.
Rao PM, Rhea JT, Novelline RA. Helical CT of appendicitis and diverticulitis. Radiol Clin North Am 1999;37:895–910.
O’Connel PR. The vermiform appendix. In: Russell RCG, Williams NS, Bulstrode CJK, editors. Bailey & Love’s short practice of surgery. 24th ed. London: Arnold; 2004.p.1203–18.
Khan MN, Davie E, Irshad K. The role of white cell count and C-reactive protein in the diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 2004;16(3):17–9.
Kessler N, Cyteval C, Gallix B, Lesnik A, Blayac PM, Pujol J, et al. Appendicitis: Evaluation of sensitivity, specificity and predictive values of ultrasonography, doppler ultrasonography and laboratory findings. Radiology 2004;230:472–8.
Arnbjörnsson E. Small intestinal obstruction after appendectomy: An avoidable complication? Curr Surg 1985;41:354–7.
Khan JS, Hassan H, Khan JA. Investigations for Acute Appendicitis: Can we rely on them? Pak J Surg 2002;18(2):27–30.
Primatesta P, Goldacre MJ. Appendicectomy for acute appendicitis and for other conditions: an epidemiological study. Int J Epidemiol 1994;23:155–60.
Korner H, Soreide JA, Sondenaa K, Pedersen EJ, Bru T, Vatten L Stability in incidence of acute appendicitis. Dig Surg 2001;18:61–6.
Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology 1986;158:355–60.
Baldisserotto M, Marchiori E. Accuracy of noncompressive sonography of children with appendicitis according to the potential positions of the appendix. AJR Am J Roentgenol 2000;175:1387–92.
Yabunaka K, Katsuda T, Sanada S, Fukutomi T. Sonographic appearance of the normal appendix in adults. J Ultrasound Med 2007;26(1):37–43.
Lee JH, Jeong YK, Park KB, Park JK, Jeong AK, Hwang JC. Operator-dependent techniques for graded compression sonography to detect the appendix and diagnose acute appendicitis. AJR Am J Roentgenol 2005;184:91–7.
Paulson EK, Kalady MF, Pappas TN. Clinical Practice. Suspected appendicitis. N Engl J Med 2003;348:23–42.
Applegate KE, Sivit CJ, Salvator AE, Borisa VJ, Dudgeon DL, Stallion AE, et al. Effect of cross-sectional imaging on negative appendectomy and perforation rates in children. Radiology 2001;220:103–7.
Field S, Morrison I. Acute Abdomen. In: Sutton D, editor. Textbook of radiology and imaging Volume I. 7th ed. China: Churchill Livingstone; 2003.p.684.
Ooms HWA, Koumans RKJ, Ho Kang You PJ, Puylaert JB. Ultrasonography in the diagnosis of acute appendicitis. Br J Surg 1991;78:315–8.
Rao PM, Rhea JT, Novelline RA, McCabe CJ, Lawrason JN, Berger DL, et al. Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix CT examination. Radiology 1997;202:139–44.
Bhutta IA, Nawaz F, Mustafa J, Muddassir N. The Role of high resolution ultrasonography in the diagnosis of acute appendicitis. J Rawal Med Coll 2004;8(2):87–9.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.