Acute and perforated appendicitis: Current experience with ultrasound‐aided diagnosis

Abstract

The clinical value of high-resolution real-time sonography for the diagnosis of acute and complicated appendicitis was prospectively investigated in 857 patients admitted with suspected appendicitis. The ultrasound findings were correlated with history and physical examination on admission. Sonography was able to make the diagnosis of appendicitis with a sensitivity of 89.7%, a specificity of 98.2%, an overall accuracy of 96.3%, and a positive and negative predictive value of 93.6% and 97%, respectively. Routine use of ultrasound before making therapeutic decisions has reduced the rate of unnecessary laparotomies from 20.3% to 11.3%. In 48 (24.7%) of 194 patients with proven appendicitis, the disease had progressed to perforation at laparotomy. History and clinical findings on admission classified 30 (62.5%) of these patients as "highly suspect;" however, 9 (18.8%) were classified as "equivocal" and 9 (18.8%) as "very unlikely." Only half (48%) of the patients with appendiceal rupture had white blood cell counts higher than 13,000/mm3 or fever above 38 degrees C (50%). Sonography enabled the visualization of the inflamed appendix and/or appendicular abscess in 44 (91.7%) patients with perforation. In 47 of 48 patients with appendiceal rupture, the ultrasound-aided diagnosis was made on hospital admission. Thus, the incidence of complicated appendicitis (24.7%) in our study population must be attributed to disease progression before admission and preclinical diagnostic delay.

Implications of Removing a Normal Appendix

“…These tools though have their own limitations, risks and costs. Sensitivity rates for ultrasound vary between 75 and 90% and specificity rates between 84 and 100%, but the efficacy of ultrasound is observer-dependent and because of the relatively low sensitivity rates, it is not useful in ruling out appendicitis [8, 9, 10, 11, 12]. Combining laboratory tests (C-reactive protein and white cell count) with US increased the diagnostic accuracy from 70.9 to 87.1% in a retrospective study of 2,351 patients [13].…”

Appendizitis Moderne Diagnostik

“…Es ist belegt, dass in diesem Kontext auch Scores geeignet sind,die klinischen Informationen effektiv zusammenzufassen. Nur im Kontext mit erfahrenen Klinikern und der Einbindung der Ultraschallergebnisse in klinische Algorithmen sind negative Laparotomieraten von unter 10% berichtet worden [2,53,69].…”

Modified Alvarado Score Versus Tzanakis Score for Diagnosing Acute Appendicitis in Changing Clinical Practice

“…This "classic" symptomatology only occurs in 50-60% of cases making the diagnosis difficult. 5 Difficulties in diagnosis especially arise in very young, elderly patients and females of reproductive age because they are more likely to have an atypical presentation, and many other conditions may mimic acute appendicitis in these patients. 6 A negative appendectomy rate of 20-40% has been reported in the literature and many surgeons advocate early surgical intervention for the treatment of acute appendicitis to avoid perforation, accepting a negative appendectomy rate of about 15-20%.…”