Accuracy and diagnostic approach of combining multiple modalities for diagnosing appendicitis among non-pregnant female of  reproductive age

M. Shahid-Ul-Islam Khan; Mohammad Mashiur Rahman; M. Maniruzzaman; Israt Jahan; Lutfunnahar .; M. Nadeem Sarkar

doi:10.18203/2349-2902.isj20220314

Authors

M. Shahid-Ul-Islam Khan 250 Bedded District Hospital, Chapainawabganj, Bangladesh http://orcid.org/0000-0001-6092-6946
Mohammad Mashiur Rahman Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
M. Maniruzzaman UHC, Shibchar, Madaripur, Bangladesh
Israt Jahan Department of Ophthalmology, National Institute of Ophthalmology and Hospital, Dhaka, Bangladesh
Lutfunnahar . UHC, Shibchar, Madaripur, Bangladesh
M. Nadeem Sarkar 250 Bedded District Hospital, Chapainawabganj, Bangladesh

DOI:

https://doi.org/10.18203/2349-2902.isj20220314

Keywords:

Appendicitis, Appendix, Ultrasonography, Alvarado score system

Abstract

Background: Appendicitis is notorious in its ability to simulate other conditions and in the frequency, it can be mimicked by other pathologies. The purpose of this study was to evaluate the accuracy of the diagnostic approach incorporating modified Alvarado score system (MASS) and ultrasonography with clinical findings. The aim of the study was to observe and evaluate different modalities of determining appendicitis among the non-pregnant female population of reproductive age

Methods: This prospective descriptive study was conducted at the department of surgery, Rajshahi College and Hospital, Rajshahi, Bangladesh. The study duration was 6 months, from February 2013 to July 2013. The study was conducted with a total of 101 women who were of reproductive age, presenting with right lower quadrant pain, who went through appendicectomy during the study period.

Results: The incidence of negative appendicectomy was 4.95% in this study. Most of the patients having appendicitis were in second and third decades with a mean age of 24.79±10.11 years. The rate of perforation in our study was 5.94%. The overall post-operative complication rate was 13.86% with minor wound infection being the most common complication. The accuracy, sensitivity, specificity, PPV and NPV of the diagnostic approach in this study were 95.05%, 98.96%, 20.00%, 95.96% and 50.00% respectively. The accuracy, sensitivity and specificity of ultrasound were found to be 29.47%, 25.56% and 100% respectively.

Conclusions: Combined use of clinical diagnosis incorporating modified Alvarado score and ultrasonography led to a significant reduction in the negative appendicectomy rate.

Metrics

Metrics Loading ...

Author Biography

M. Shahid-Ul-Islam Khan, 250 Bedded District Hospital, Chapainawabganj, Bangladesh

250 Bedded District Hospital, Chapainawabganj, Bangladesh.

References

Julie AM, Walter EL, Katherine SV et al. Risk adverse outcomes after the surgical treatment of appendicitis in adults. Ann Surg. 2003;238(1):59-66.

Pal KM, Khan A. Appendicitis, a continuing challenge. J Pak Med Assoc. 1998;48:189-92.

Fitz RH. Perforating inflammation of the vermiform appendix with special reference to its early diagnosis & treatment. Am J Med Sci. 1886;92:321-46.

Malt RA. The Perforated appendix. N Engl J Med. 1986;315:1546.

Gilmour IEW, Lowdon AGR. Acute appendicitis. Edinb Med J. 1952;59:361.

Rothrock SG, Green SM, Dobson M, Colucciello SA, Simmons CM. Misdiagnosis of appendicitis in nonpregnant women of childbearing age. J Emerg Med. 1995;13:1-8.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557-65.

Al-Fallouji MAR. Postgraduate Surgery, the Candidate's Guide. 2nd edition. Oxford: Butterworth-Heinemann. 1998;388-9.

Kanumba ES, Mabula JB, Rambau P, Chalya PL. Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis a Bugando Medical Centre, Mwanza, Tanzania. BMC Surg. 2011;17(11):4.

Williams RA and Myers P. Pathology of the Appendix and its surgical treatment. London: Chapman and Hall Inc. 1994;1-8,9-30.

Ma KW, Chia NH, Yeung HW, Cheung MT. If not appendicitis, then what else can it be? A retrospective review of 1492 appendicectomies. Hong Kong Med J. 2010;16:12-7.

Nautiyal H, Ahmad S, Keshwani NK, Awasthi DN. Combined use of Modified Alvarado Score and USG in decreasing negative appendicectomy rate. Indian J Surg. 2010;72:42-8.

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.

Memon ZA, Irfan S, Fatima K, Iqbal MS, Sami W. Acute Appendicitis: Diagnostic Accuracy of Alvarado scoring system. Asian J Surg. 2013;pii:S1015-9584(13)00033-X.

Engin O, Calik B, Yildirim M, Coskun A, Coskun GA. Gynecologic pathologies in our appendectomy series and literature review. J Korean Surg Soc. 2011;80:267-71.

Hossain MM, Sobhan MA, Talukder SI. Acute appendicitis: faults and fallacies in clinical diagnosis. Dinajpur Med Col J. 2012;5(1):11-5.

Lewis FR, Holcroft JW, Boey. Appendicitis: a critical review of the diagnosis and treatment in 1000 cases. Arch Surg. 1975;110:677-84.

Jeffrey RB, Laing FC, Lewis FR. Acute appendicitis High-resolution real-time US findings. Radiology. 1987;163:11-4.

Hoffman J, Rasmussen O. Peritoneal lavage as an aid in the diagnosis of acute peritonitis of non-traumatic origin. Br J Surg. 1989;119:681-5.

Adams D, Calthrope F, Brooks D. High-resolution Real-Time ultrasonography, a new tool in the diagnosis of acute appendicitis. Am J Surg. 1988;155:93-7.

John H, Neff U, Kelemen M. Appendicitis diagnosis today: clinical and ultrasonic deductions. World J Surg. 1993;17:243-9.

Ashmawy IH, El-Fayoumi TAH, Bessa SS, Awad ATF. Evaluation of combined graded compression ultrasonography with Alvarado Score in the diagnosis of acute appendicitis. Bull Alex Fac Med. 2006;42(1):29-34.

Birnbaum BA, Jeffrey RB, Jr. CT and sonographic evaluation of acute right lower quadrant pain. AJR. 1998;170:361-71.