Background: Appendicitis is a common condition which frequently requires emergency surgery and has postoperative wound infection has been reported in few cases which can be influenced by many factors, the most important being surgical skill and technique and the criteria used to define the infection. Bacteria play an important role in appendicitis and the local application of antibiotics or antiseptics can reduce the incidence of wound infection. In this study, we analyse the microbiology culture of acute appendicectomy specimen and its correlation with wound infection.Methods: This is a randomised control test study which was carried out 56 patients with appendicitis. The swab was taken from appendix lumen after appendicectomy and wound infection was sent to laboratory to carry out histology findings and infective organisms respectively. All patients were followed postoperatively for wound infection.Results: Bacteria was isolated from 60% swabs taken from appendix lumen in which gram-negative bacilli isolated as commonest bacteria among which perforated appendicitis shows 66.7% isolation of bacteria. Wound infection among patients underwent appendicectomy was 21%. Gram-negative bacilli were isolated from almost all swabs (100%) taken from wound infection.Conclusions: From this study and results, it shows gram negative bacilli was the commonest organisms isolated from the swabs taken from both appendix lumen and wound infection.
BACKGROUND Ultrasonography is widely used for diagnosis of appendicitis. [1-4] There have been not much literature for diagnosing perforated appendicitis by evaluating wall pattern and wall thickness by USG. In this study, we evaluated wall thickness and wall pattern for diagnosing perforated appendix. Aims and Objectives-Ultrasonography characterisation of wall pattern in inflamed appendix compared to normal appendix. Correlation of wall pattern and discontinuity of wall of perforated and non-perforated appendicitis with post-operative findings. MATERIALS AND METHODS Study Type-Observational Diagnostic Study. Study of the role of ultrasonography in characterisation of wall pattern and wall thickness in inflamed appendix in correlation with per-operative findings. Wall pattern of appendix is classified into thickened wall with preservation of or intact wall pattern, diffuse loss of normal wall pattern and focal discontinuity in submucosal layer. Study was conducted in the period, September 2015 to April 2017. 200 patients with positive findings for appendicitis by ultrasonography were selected for this study. Scanning RIF with graded compression technique with Transducers Linear Array 6 MHz to 11 MHz and curvilinear array 3.0 to 6 MHz. Patients are excluded who presented with symptoms related to other organ systems and when ultrasound was not used as an initial evaluation of method. Any patient having excessive bowel gas, in whom visualisation of appendix becomes difficult, is excluded from the study. Ultrasonography findings are correlated only with peroperative finding. RESULTS At surgery 52 (26%) of the 200 patients proved to have perforated appendicitis and 148 patients (76%) did not have perforated appendicitis. Focal discontinuity and loss of normal wall pattern are common if diameter of appendix is more than 8 mm, though it may present in lesser diameter. When there is only thickened wall with no discontinuity, the specificity to rule out perforation is 100% with confidence interval of 16% to 100%. As there is no perforation by USG in this table, sensitivity is 0%. The sensitivity to diagnose perforation in focal discontinuity of submucosal layer is 89% and specificity is 75% with accuracy of 76.92%. The sensitivity to diagnose perforation in diffuse loss of wall pattern is 68% (CI 50% to 83%) and specificity is 80% (CI-44% to 97%) with accuracy of 71% (CI-55.42% to 84.28%). Sensitivity and accuracy of detecting perforation by USG is highest for focal discontinuity in submucosal layer of appendix. Sensitivity for non-perforated appendicitis is high for intact wall pattern with thickened wall. CONCLUSION Ultrasonography is widely used to diagnose acute appendicitis. Just to diagnose appendicitis may not be adequate for the surgeon to plan the management. Status regarding perforation may be very important for further management. This is the first attempt to find correlation between wall pattern and wall thickness for perforation. Focal discontinuity in submucosal layer of appendix has more sensitivity for pe...
BACKGROUND Studies regarding accuracy of Ultrasonography and Computed Tomography for diagnosis of appendicitis is not frequently done after the advancement in ultrasonography instrumentation. Imaging studies evolves rapidly due to advancement in technology. It is mandatory to update imaging methods for various pathologies. Aims and Objectives-To assess and compare accuracy of Ultrasonography and Computed Tomography to diagnose acute appendicitis in patients with suspected acute appendicitis. MATERIALS AND METHODS Study Type-Descriptive study for diagnostic accuracy. Between January 2014 and January 2016, 400 patients who presented to emergency department with high clinical suspicion of appendicitis were evaluated with Ultrasonography and Computed Tomography. Computed Tomography examinations were performed with a sixteen-slice helical CT scanner (GE, Brivo, 385 series) by means of a rapid thin-scanning technique. For the Ultrasonography examinations, we used 5 to 11 MHz linear array, 3 to 6 MHz curved array (GE-Voluson S6). Curved array transducers were used in obese patients to allow deeper penetration. Ultrasonography examinations were performed using the graded compression technique described by Puylaert. [1,2] The Computed Tomography and Ultrasonography examinations were evaluated separately within 1 hour by two radiologists who were unaware of the findings on the other examination. The surgeon was not informed about the radiologic diagnosis. The surgeon decides further management in these patients based on clinical and laboratory data. The diagnosis of acute appendicitis at surgery was established based on macroscopic findings. A macroscopically normal appendix at laparoscopy was left intact. A normal looking appendix at laparotomy by a split-muscle incision was excised. All excised appendix was microscopically analysed by histology using paraffin sections for final diagnosis of acute appendicitis. All data underwent statistical analysis using the McNemar test. The study protocol was approved by the hospital's ethical committee for human studies. RESULTS The sensitivity of Ultrasonography and Computed Tomography was 95% and 93% respectively, and the specificity was 82% and 75% respectively. The positive predictive value was 91% and 87% respectively, and the negative predictive value was 90% and 85% respectively. The accuracy of Ultrasonography was 91% and CT was 87% respectively. Based on the McNemar test results, the calculated 'p' value for sensitivity, specificity and accuracy was not less than 0.05, which indicates that CT was not superior to Ultrasonography in the diagnosis of acute appendicitis. On comparing Z= 1.43 it is less than the level of significance value, i.e. 1.96, therefore not significant which concludes that Computed Tomography is not superior to Ultrasonography for diagnosing acute appendicitis. CONCLUSION USG for the diagnosis of acute appendicitis has accuracy same as that of Computed Tomography. Wall pattern and wall thickness is better studied with USG. Further studies are needed to co...
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