Advantage of ultrasonography in the diagnosis of acute appendicitis at Al-Karama Teaching Hospital


  • Mohammed Hillu Surriah Department of Surgery, Al-Karama Teaching Hospital, Baghdad, Iraq
  • Amine Mohammed Bakkour Department of Surgery, Al-Karama Teaching Hospital, Baghdad, Iraq
  • Nidaa Ali Abdul Hussain Department of Obstetrics and Gynaecology, Al-Yarmouk Teaching Hospital, Baghdad, Iraq



Accuracy, Appendicitis, Iraq, Ultrasonography, Validity


Background: The clinical diagnosis of acute appendicitis remains a challenge to surgeons. Different aids were introduced to improve the diagnostic accuracy. Among these modalities, ultrasonography is simple, easily available, non-invasive, convenient and cost effective. The aim of the study was to determine the validity of ultrasound in diagnosis of the acute appendicitis in those with clinically diagnosed patients.

Methods: A cross sectional study was carried out in Al-Karama teaching hospital for thirty months from the period of 1st June 2016 to 1st December 2018. All patients with suspected appendicitis underwent clinical evaluation then sent for US. Results of surgeries, where relevant, were compared against US results. Positive and negative appendices on histopathology were regarded in accordance to the criteria which was negative appendectomy was defined as normal looking appendix and absence of acute inflammation on histopathology while positive cases included appendices showing acute inflammatory changes. Sensitivity, specificity and overall accuracy was calculated.

Results: A total of 435 patients with suspected appendicitis, males 224 (51.49%) and females 211 (48.50%) were included in present study. There were no significant differences between patients with positive and negative histopathology findings regarding presenting symptoms. There was a significant association between (cough sign, localized tenderness sign and pointing sign) and patients with positive histopathology findings. Regarding to the validity results of ultrasound in comparison to histopathology findings were  accuracy 87.6%, sensitivity 87.8%, specificity 85.3%, positive predictive value 98.6% and negative predictive value 62.8%.

Conclusions: The ultrasonography had a good accuracy, sensitivity and specificity in diagnosing acute appendicitis cases. Negative with ultrasonography results should be re-examined with different diagnostic technique like CT-scan.


Dox I, Melloni BJ, Eisner GM, eds. Melloni’s Illustrated Medical Dictionary. 4th ed. NY: Informa-healthcare; 2010: 58.

Standring S, Anand N, Birch R, Collins P, Crossman AR, Gleeson M, eds. Anatomy of Vermiform Appendix. In: Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Elsevier; 2015: 1138.

Berry JO, Malt RA. Appendicitis near its centenary. Ann Surg. 1984;200(5):567.

Gwynn LK. The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. J Emerg Med. 2001;21(2):119-23.

Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006;333(7567):530.

Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. Western J Emerg Med. 2014;15(7):859.

Douglas CD, Macpherson NE, Davidson PM, Gani JS. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ. 2000;321(7266):919.

Puylaert JB. Mesenteric adenitis and acute terminal ileitis: US evaluation using graded compression. Radiol. 1986;161(3):691-5.

Lim HK, Lee WJ, Kim TH, Namgung S, Lee SJ, Lim JH. Appendicitis: usefulness of color Doppler US. Radiol. 1996;201(1):221-5.

Quillin SP, Siegel MJ. Appendicitis: efficacy of color doppler sonography. Radiol. 1994;191:557-60.

Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-25.

William NS, Bulstrod CJK, O’ Connell PR, eds. The Vermiform Appendix. Baily and Love’s Short Practice of Surgery. 26th ed. London, NY: Taylor andFrancis; 2013: 1199-1203.

Charles BF, Jaffe BM. Appendicitis. In: Schwartz’s Principles of Surgery. 10th ed. NY: McGraw-Hill; 2015: 1243.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.

Reginelli A, Mandato Y, Solazzo A, Berritto D, Iacobellis F, Grassi R. Errors in the radiological evaluation of the alimentary tract: part II. In: Seminars in Ultrasound, CT and MRI. WB-Saunders; 2012: 33(4): 308-317.

Gracey D, McClure MJ. The impact of ultrasound in suspected acute appendicitis. Clin Radiol. 2007;62(6):573-8.

Overhagen H. Ultrasound of appendicitis and its differential diagnosis. Puylaert JBCM. Heidelberg, NY; 1990: 118.

Quigley AJ, Stafrace S. Ultrasound assessment of acute appendicitis in paediatric patients: methodology and pictorial overview of findings seen. Insights Imaging. 2013;4(6):741-51.

Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiol. 2000;215(2):337-48.

Chesbrough RM, Burkhard TK, Balsara ZN, Goff WB, Davis DJ. Self-localization in US of appendicitis: an addition to graded compression. Radiol. 1993;187(2):349-51.

Subash K, De A, Pathak M, Sathian B. Diagnostic role of ultrasonography in acute appendicitis: a study at a tertiary care hospital. Am J Pub Heal Res. 2015;5(3):23-8.

Hiwa O. Role of ultrasound in patients with high clinical suspicion of acute appendicitis. Zanco J Med Sci. 2006;9(1).

Hanna MK, Kamal ZB, Hindosh LN, Hussein WA. The role of ultrasound in the diagnosis of acute appendicitis: a prospective study. Iraq Acad Sci J. 2014;13(2):226-9.

Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, et al. Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature. Crit Ultrasound J. 2013;5(1):S2.

Parsijani PJ, Zarandi NP, Paydar S, Abbasi HR, Bolandparvaz S. Accuracy of ultrasonography in diagnosing acute appendicitis. Bulletin Emerg Trauma. 2013;1(4):158.

Elghany EA, Ali GG. Multidetector row helical CT and US in diagnosing appendicitis. Egypt J Radiol Nuclear Med. 2011;42(2):139-45.

Jeffrey RB, Jain KA, Nghiem HV. Sonographic diagnosis of acute appendicitis: interpretive pitfalls. AJR. Am J Roentgenol. 1994;162(1):55-9.

Boyd CA, Riall TS. Unexpected gynaecologic findings during abdominal surgery. Current Prob Surg. 2012;49(4):195-251.

Nasiri S, Mohebbi F, Sodagari N, Hedayat A. Diagnostic values of ultrasound and the modified Alvarado scoring system in acute appendicitis. Int J Emerg Med. 2012; 5(1):26.

Paajanen H, Tainio H, Laato M. A chance of misdiagnosis between acute appendicitis and renal colic. Scandinavian J Urol Nephrol. 1996;30(5):363-6.

Barlas SU, Günerhan Y, Palanci Y, Işler B, Çağlayan K. Epidemiological and demographic features of appendicitis and influences of several environmental factors. Turk J Trauma Emerg Surg. 2010;16(1):38-42.

Lohar HP, Calcuttawala MA, Nirhale DS, Athavale VS, Malhotra M, Priyadarshi N. Epidemiological aspects of appendicitis in a rural setup. Med J of Dr. DY Patil Uni. 2014;7(6):753.






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