A study on the clinical and sonological correlation in the diagnosis and management of acute appendicitis in a tertiary care centre
Keywords:Alvarado Score, Appendicitis, Histopathology, Ultrasonography
Background: Acute appendicitis is the most common acute surgical condition of the abdomen requiring early intervention. The diagnosis is often challenging and the decision to operate in an emergency setting is always debatable. Alvarado score for diagnosis of acute appendicitis is easy and additional tools like sonography results in accurate diagnosis. The aim was to evaluate accuracy of the clinical Alvarado scoring system, radiological findings and histopathological examination for the diagnosis of acute appendicitis.
Methods: 100 cases of acute abdomen admitted in PES institute of medical sciences and research, Kuppam from December 2016 to June 2018 were included. Clinical examination was done and all patients were subjected to ultrasound abdomen examination and other relevant blood and imaging investigations.
Results: Out of 100 patients 62 were males and 38 were Females. Most common symptom was pain in the right iliac fossa and patients with Alvarado Score 7 or > 7 subjected to USG followed by emergency appendectomy showed positive operative findings and histopathological findings. The overall specificity of abdominal USG in the diagnosis of acute appendicitis was 88.09% and sensitivity was 95.37%.Conclusions:The Alvarado scoring system combined with ultrasound can therefore be used as a cheap and less expensive useful, reliable and non invasive way of confirming acute appendicitis thus helps in reducing negative appendectomy rate. The overall accuracy of diagnosis of acute appendicitis goes up to 90% with positive histopathological findings.
Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendicectomy in United States. Am J Epidemiol. 1990;132(5): 910-25.
Fitz RH. Perforating inflammation of the vermiform appendix with special refernce to its early diagnosis and treatment .Trans. Assoc. Am. Physicians. 1886;1(184):321.
Reddy GVB, Subramanyam VV, Veersalingam B, Sateesh S, Bangla G, Rao PS. Role of Alvarado score in the diagnosis of acute appendicitis. Int J Res Med Sci. 2013;1:404-8.
Singh CA, Singh AP, Sajith BSM, Gaharwar APS. Role of Alvarado score in diagnosis and management of acute appendicitis. Int J Sci Stud. 2016;4(6):173-7.
Sharma R, Kasliwal DK, Sharma RG. Evaluation of negative appendicectomy rate in cases of suspected acute appendicitis and to study the usefulness of ultrasonography in improving the diagnostic accuracy. Indian J Surg. 2007;69:194-7.
Alvarado A. A Practical Score for early diagnosis of acute appendicitis, Ann. Emerg. Med. 1986;15(5):557-64.
Giljaca V, Nadarevic T, Poropat G, Nadarevic VS, Stimac D. Diagnostic Accuracy of Abdominal Ultrasound for Diagnosis of Acute Appendicitis: Systematic Review and Meta-analysis. World J Surg. 2017;41:3792-7.
Puylaert JBCM. Acute appendicitis-US evaluation using Graded compression, Radiol. 1986;158;355-60.
Nasiri S, Mohebbi F, Sodagari N, Hedayat A. Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis. Int J Emerg Medicine. 2012;5:26.
Taj-Adean KAH. Sensitivity, Specificity and predictive values of ultrasonography in the diagnosis of acute appendicitis. Medic J Babylon. 2008;5(3-4):595-600.
Parsijani JP, Zarandi PN, Abbasi HR, Bolandparvaz S. Accuracy of Ultrasonography in Diagnosisng Acute Appendicitis. Bull Emerg Trauma. 2013;1(4):158-63.
Schwartz SI, Appendix, In: Schwartz SI, ed, Principles of Surgery, 10th ed. New york: Megraw Hill. 2015:1241-62.
Abu-Yousf MM, Phuillips ME, Franken EA, Al-Jurf AS, Smith WL; Sonography of acute appendicitis: a critical review: Crit Rev Diagn Imaging. 1989;29(4):381-408.
Gallindo G, Fadrique N, Calleja F. Evaluation of ultrasonograpy and clinical diagnostic scoring in suspected appendicitis. Br J Surg. 1998;85:3740.
Mohanty S, Kaushik SI, Evaluation of modified Alvarado score in decreasing negitive appendectomy rate-our experience, IJS. 2000;62(5);342-3.
Geryk B,Kubikova E,Jakubovsky J,;clinical histopathologic picture of acute appendicitis in children; Rozhchir. 2000;79(5);211-4.
Bhattacharjee PK, Chowdary T, Roy D. Prospective Evaluation of modified Alvarado Score for diagnosis of acute appendicitis: J Ind Medic Association. 2002;100(5):310-1.
George Mathews John, Siba Prasad Pattanayak, Charan Panda, K. Raja Ram Mohan Rao, Evaluation of Ultrasonography as a Useful Diagnostic Aid in Appendicitis. IJS 2002;64(5):436-9.
Pieper R, Kager L.The incidence of acute appendicitis and appendectomy. Acta Chir Scand. 1982;148:45–9.
Doraiswamy NV. Leucocyte counts in the diagnosis and prognosis of acute appendicitis in children. British Journal Surg. 1979;66(11):782-4.
Kallan M, Talbot D, Cunliffe WJ, Rich AJ,“Evaluation of modified alvarod Score in diagnosis of Acute Appendicitis : A prospective study “. Ann, RCS of Engl. 1994;76(6):418-9.
Owen TD, William H. Stiff G, Jenkenson LR, Rees B1: Evaluation of Alvarado Score in Acute Appendicitis: J Social Medic. 1992;85,87-8.
Elongovan S. Clincial and laboratory findings in acute appendicitis in the elderly, J Am Board Fam Pract. 1996:9:75-8.
Jeffrery RB Jr, Laing FC, Townsend RR. Acute appendicitis: sonagraphic criteria based on 250 cases. Radiol. 1988;167:327-9.
Zeidan BS, Wasser T, Nicholas GG. Ultrasonography in the diagnosis of acute Appendicitis. J R Coll Surg Edinb. 1997;42:24-6.
Fa EM, Cronan JJ. Compression ultrasonography as an aid in the differential diagnosis of appendicitis. Surg Gynecol Obstet. 1989;169:290-8.
Adams DH, Fine C, Brooks PC. High-resolution real-time ultrasonography: A new tool in the diagnosis of acute appendicitis. Am J Surg. 1988; 155(1):93-7.