Alternative diagnosis for pain in patients who underwent appendectomies for normal appendices and the incidence of negative appendectomies

Ahmed, Hiwa Omer; Muhammed, Ali

doi:10.33899/mmed.2011.34694

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…These two stages were the most common in earlier studies. 10,11 Whereas gangrene and perforation were noted in fewer cases i-e 13 (7.5%) and 8 (4.6%) respectively. 17,18 These results are in concordance with findings of study previous studies Percentage of negative appendectomies was 15.5% i-e 27 operated cases had normal appendix.…”

Section: Discussionmentioning

confidence: 96%

“…9 Other imaging techniques used are ultrasound, CT, MRI. 10 in perforation and sepsis leading to morbidity of 10% and mortality of 1 to 5%. 11 In USA pre-operative imaging like CT lowers the rate of normal appendectomy to 5.6%(from 20.6%) and hence lowers perforation rates, but this must be tailored against radiation risk especially in children.…”

Section: Introductionmentioning

confidence: 99%

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Frequency of obstructive appendicitis in patients undergoing open appendectomies.

Junaid

Usama

Shah

et al. 2022

TPMJ

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Objectives: To determine the frequency of obstructive appendicitis in patients undergoing open appendectomies for acute appendicitis. Negative appendectomy rate will also be calculated. Study Design: Cross-Sectional study. Setting: Department of General Surgery of Ayub Teaching Hospital Abbottabad. Period: September 2019 to February 2020. Material & Methods: The study population included patients of any gender, age from 10 years to 45 years found to have acute appendicitis diagnosed by clinical and ultrasound findings and confirmed by open appendectomy. Sample size of 174 was calculated, using WHO software for sample size calculation. After detailed examination and investigations, patients who underwent open appendectomy as per advice of visiting consultants were included; by filling predesigned research per forma. Results: Mean age of the patients was 26.33±11.177 and more than half were male i-e 106 (60.9%). Where majority i-e 93(53.4%) of appendices were of obstructed type, this wasn’t statistically higher than the non-obstructed type (p=0.363). In frequency of operative findings, acutely inflamed appendix was most common with 71(40.8%) patients. While suppurative, gangrenous and perforated samples were noted in 55(31.6%), 13(7.5%) and 8(4.6%) cases respectively. Negative appendectomy was done in 27(15.5%) patients. Conclusion: This study concluded that obstruction was noted in more than half of the cases i-e 93(53.4%), but it was not statistically higher from the other subtype. Negative appendectomy rate was 15.5%; higher than globally set target, but was similar to the one noted in Pakistan by previous researchers.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Frequency of obstructive appendicitis in patients undergoing open appendectomies.

Junaid

Usama

Shah

et al. 2022

TPMJ

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“…Clinical and laboratory scores can be used to rule out the diagnosis of appendicitis [3,6]. However, AA remains diagnostically challenging, as the negative appendectomy (NA) incidence can reach up to 10-30% [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

The Dynamics of Inflammatory Markers in Patients with Suspected Acute Appendicitis

et al. 2021

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Background: Laboratory tests of inflammatory mediators are routinely used in the diagnosis of acute appendicitis (AA). The aim of this study was to evaluate the differences of dynamics of inflammatory markers of the blood in patients with suspected acute appendicitis between complicated AA (CAA), non-complicated AA (NAA), and when AA was excluded (No-AA). Methods: This was a retrospective analysis of prospectively collected data of patients presented to the Emergency Department (ER) of a tertiary hospital center during a three-year period. All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. The dynamics of inflammatory markers of the blood between different types of AA (No-AA, NAA or CAA) during different periods of time are presented. Results: A total of 453 patients were included in the study, with 297 patients in the No-AA group, 99 in the NAA group, and 57 in the CAA group. White blood cell (WBC) count in the No-AA decreased with time, with a statistically significant difference between the <8 h and 25–72 h group. The neutrophils (NEU) percentage decreased in the No-AA group and was statistically significantly different between the <8 h and 25–72 h and <8 h and >72 h groups. C-reactive protein (CRP) increased significantly in the No-AA group throughout all time intervals, and from the first 24 h to the 25–72 h in the NAA and CAA groups. There was a statistically significant difference between the WBC count between No-AA, NAA, and No-AA and CAA groups during the first 24 and 24–48 h. There was a statistically significant difference between NEU percentage and LYMP percentage and in the NEU/LYMP ratio between No-AA and CAA groups through all time periods. CRP was significantly higher in the first 24 h in the CAA than in the No-AA group, and in the 24–48 h in the CAA group than in the No-AA and NAA groups. The linear logistic regression model, involving inflammatory mediators and clinical characteristics, showed mediocre diagnostic accuracy for diagnosing AA with an AUC of 0.737 (0.671–0.802). Conclusions: Increasing concentrations of inflammatory markers are more characteristic in CAA patients than in No-AA during the first 48 h after onset of the disease. A combination of laboratory tests with clinical signs and symptoms has a mediocre diagnostic accuracy in suspecting AA.

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“…About one fifth to one third of appendectomies are negative and revealing normal appendices 5,16,17 , adverse outcomes and mortality after the operations of negative appendectomies are loosely defined in the literature, the work is aiming to explore potential morbidity and mortality associated with negative appendectomy.…”

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confidence: 99%

A five-year longitudinal observational study in morbidity and mortality of negative appendectomy in Sulaimani teaching Hospital/Kurdistan Region/Iraq

Ahmed

Muhedin

Boujan

et al. 2020

Sci Rep

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The most common surgical emergency is suspected acute appendicitis, the lifetime risk of acute appendicitis is estimated to be 8.6% for men and 6.7% for women, with a male to female ratio of 1.4:1; correct diagnosis can be made in 70-80% of patients after the operations about 32% of appendectomies revealed normal appendices and meanwhile appendectomy has a considerable morbidity and mortality. The aim is to explore potential morbidity and mortality associated with negative appendectomy. Prospective case series study, including 5847 patients, who were suspected to have acute appendicitis over a period of five years from 1st December 2013 to 30th November 2018, in emergency department of Sulaimani Teaching Hospital. All the collected data were collected, organized then analyzed by Statistical Package for the Social Sciences version 21. Morbidity in the patients with negative appendectomies occurred in patients in the form of 90 (01.91%) wound infection, 48 (01.02%) intestinal obstruction and last 15 (00.32%) patients developed septicemia. While mortality in negative appendectomy patients was 21, (00.45%). Negative appendectomies have high rates of morbidity and mortality, knowing real rates may help in considering various policies and may be helpful to elude avoidable complications and potential mortality. Non traumatic acute abdomen is 4-8% of adults admitted to the emergency department 1,2. The most common surgical emergency is suspected acute appendicitis, "the lifetime risk of acute appendicitis is estimated to be 8.6% for men and 6.7% for women" 3. Males are affected one and half more times than females 4 while definite diagnosis could be done in 70-80% of patients 1 , after the operations about 32% of appendectomies revealed normal appendices 5 , In females of child bearing age, gynecological pathologies are simulating acute appendicitis 1 , which may increase the prevalence of negative appendectomies. Clinical suspicion of acute appendicitis is mostly done on patient's symptoms and physical findings, including Alvarado score "which has adding accuracy (98.60%) versus computerized tomography (CT) scan (99.03%) 6. Although laboratory blood and urine investigations and simple imaging like plain erect abdominal radiogram and ultrasonography of abdomen and pelvis may aid in accuracy of the diagnosis. "But are not as helpful as magnetic resonance imaging (MRI) and CT scan, which have accuracy of 98% in diagnosing acute appendicitis and lastly diagnostic laparoscopy" 1,3,7-10 .

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Alternative diagnosis for pain in patients who underwent appendectomies for normal appendices and the incidence of negative appendectomies

Cited by 3 publications

References 23 publications

Frequency of obstructive appendicitis in patients undergoing open appendectomies.

Frequency of obstructive appendicitis in patients undergoing open appendectomies.

The Dynamics of Inflammatory Markers in Patients with Suspected Acute Appendicitis

A five-year longitudinal observational study in morbidity and mortality of negative appendectomy in Sulaimani teaching Hospital/Kurdistan Region/Iraq

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