A study to find out correlation between clinical diagnosis and histopathological diagnosis in patients with acute appendicitis undergoing surgical treatment
Keywords:Acute appendicitis, Appendectomy, Alvarado score, Clinical diagnosis, Histopathological diagnosis
Background: Acute appendicitis is one of the most frequent abdominal emergencies and appendectomy subsequently the most common emergency operation performed all over the world. The aim of the study is to evaluate the reliability of Clinical Diagnosis for diagnosis of acute appendicitis and correlate it with the gold standard and absolute diagnostic modality, histopathology.
Methods: This is a prospective study carried out in 150 patients who were admitted under department of surgery, AFMC Pune, Maharashtra from 1st July 2014 to 31st June 2016 for a clinical diagnosis of acute appendicitis.
Results: In our study overall negative appendectomy rate was 18.7% (12.37% in male and 30.19% in female). Hence in the overall females had more negative appendectomy rate compared to males. In our series a score of >7 using Alvarado system had a total sensitivity of 72.95%. While sensitivity increases to 99.18% when score of >5 used as cut-off.Conclusions:Alvarado scoring system is beneficial in decreasing negative appendectomy rate and thus reduces complication rates. It is effective in the diagnosis of acute appendicitis in both men and females but some other diagnostic modality may be necessary to ascertain the diagnosis in females along with the clinical scoring system to rule out other pelvic pathology and to reduce negative appendectomy rate in females.
Darwin C. The descent of man, and selection in relation to sex: Murray; 1888.
Smith HF, Parker W, Kotzé SH, Laurin M. Multiple independent appearances of the cecal appendix in mammalian evolution and an investigation of related ecological and anatomical factors. Comptes Rendus Palevol. 2013;12(6):339-54.
Bollinger RR, Barbas AS, Bush EL, Lin SS, Parker W. Biofilms in the large bowel suggest an apparent function of the human vermiform appendix. J Theoretical Biol. 2007;249(4):826-31.
Jaffe BM, Berger DH. Chapter 30: The appendix. Schwartz’s Principles of Surgery, Ninth Edition. New York, NY: McGraw Hill Professional; 2009: 1074-1091.
Hoffmann J, Rasmussen O. Aids in the diagnosis of acute appendicitis. British J Surg. 1989;76(8):774-9.
John H, Neff U, Kelemen M. Appendicitis diagnosis today: clinical and ultrasonic deductions. World J Surg. 1993;17(2):243-9.
Tzanakis NE, Efstathiou SP, Danulidis K, Rallis GE, Tsioulos DI, Chatzivasiliou A, et al. A new approach to accurate diagnosis of acute appendicitis. World J Surg. 2005;29(9):1151-6.
Carr NJ. The pathology of acute appendicitis. Annals Diagnostic Pathol. 2000;4(1):46-58.
Jones P. Suspected acute appendicitis: trends in management over 30 years. British J Surg. 2001;88(12):1570-7.
Lee S, Walsh A, Ho H. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Annals Emerg Med. 2002;40(5):533-4.
Balthazar E, Megibow A, Hulnick D, Gordon R, Naidich D, Beranbaum E. CT of appendicitis. Am J Roentgenol. 1986;147(4):705-10.
Takada T, Yasuda H, Uchiyama K, Hasegawa H, Shikata J. Ultrasonographic diagnosis of acute appendicitis in surgical indication. Inter Surg. 1985;71(1):9-13.
Clarke P, Hands L, Gough M, Kettlewell M. The use of laparoscopy in the management of right iliac fossa pain. Annals Royal Coll Surg England. 1986;68(2):68.
Rypins EB, Evans DG, Hinrichs W, Kipper SL. Tc-99m-HMPAO white blood cell scan for diagnosis of acute appendicitis in patients with equivocal clinical presentation. Annals Surg. 1997;226(1):58.
Arnbjörnsson E, editor Scoring system for computer-aided diagnosis of acute appendicitis. The value of prospective versus retrospective studies. Annales Chirurgiae Gynaecologiae; 1984.
Teicher I, Landa B, Cohen M, Kabnick LS, Wise L. Scoring system to aid in diagnoses of appendicitis. Annals Surg. 1983;198(6):753.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Annals Emerg Med. 1986;15(5):557-64.
Lamparelli MJ, Hoque H, Pogson CJ, Ball A. A prospective evaluation of the combined use of the modified Alvarado score with selective laparoscopy in adult females in the management of suspected appendicitis. Annals Royal Coll Surg England. 2000;82(3):192.
Shrivastava UK, Gupta A, Sharma D. Evaluation of the Alvarado score in the diagnosis of acute appendicitis. Trop Gastroenterol. 2004;25:184-6.
Denizbassi A, Unluer EE. The role of the emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis compared with the general surgery resident. EJEM. 2003;10:296-301.
Kalan M, Talbot D, Cunliffe W, Rich A. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Annals Royal Coll Surg England. 1994;76(6):418.
Macklin C, Radcliffe G, Merei J, Stringer M. A prospective evaluation of the modified Alvarado score for acute appendicitis in children. Annals Royal Coll Surg England. 1997;79(3):203.
Malik A, Wani N. Continuing diagnostic challenge of acute appendicitis: evaluation through modified Alvarado score. Australian New Zealand J Surg. 1998;68(7):504-5.
Dey S, Mohanta PK, Baruah AK, Kharga B, Bhutia KL, Singh VK. Alvarado scoring in acute appendicitis-a clinicopathological correlation. Indian J Surg. 2010;72(4):290-3.
Luhmann J, Schneider A, Braun L. Diagnosis of appendicitis: only experience helps. Medizinische Klinik. 1980;75(8):303-6.
Al-Hashemy AM, Seleem MI. Appraisal of the modified Alvarado Score for acute appendicits in adults. Saudi Med J. 2004;25(9):1229-31.
Waskale V, Singh A, Gaharwar A, Singh V. Evaluation of role of Alvarado score in diagnosis of acute appendicitis: a prospective study. 2016;2(6):41-4.