Diagnostic Challenges in Acute Appendicitis

Harrison, Sanjay; Benziger, Harrison

doi:10.5772/25696

Cited by 2 publications

(3 citation statements)

References 92 publications

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“…Gently squeezing the appendix stump with a Johan or other non-toothed grasper, will often yield a faecolith that should be carefully removed and as we know is often the causative agent in appendicitis 7. Other technical points to consider are that direct visualisation of the appendix at all times until safely in a bag to minimise risk of inadvertent contamination from appendix contents.…”

Section: Discussionmentioning

confidence: 99%

Retained faecolith: an avoidable complication of laparoscopic appendicectomy

Knight¹,

Brar²,

Clark³

2013

BMJ Case Reports

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Section: Discussionmentioning

confidence: 99%

Retained faecolith: an avoidable complication of laparoscopic appendicectomy

Knight¹,

Brar²,

Clark³

2013

BMJ Case Reports

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“…Acute appendicitis, which has a lifetime prevalence of approximately one in seven worldwide, presents as an abdominal surgical emergency in which a delay or missed diagnosis can lead to complications resulting in morbidity and mortality [ 1 ]. With clinical assessment playing a major role in diagnosis and treatment, subtle clinical features in early stages and atypical presentation make diagnosis challenging, even for an experienced clinician [ 2 ]. Tests and procedures used to diagnose appendicitis include a wide range of options from physical examination, blood tests, and urine tests to imaging tests such as an abdominal X-ray, abdominal ultrasound, computerized tomography scan, or magnetic resonance imaging to help confirm appendicitis or find other causes for the patient's pain [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…A score of seven or more is considered highly suggestive of acute appendicitis. USG scoring criteria are based on reports by Stephens et al, Harrison et al, Fu et al [ 1 , 2 , 9 ]; a sonological score of more than six is diagnostic of appendicitis. The present study was planned to determine the reliability of already existing MAS and USG findings individually and together in the diagnosis of acute appendicitis correlating with the operative findings and histopathological outcome of the appendix specimen.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Diagnostic Reliability of Modified Alvarado Scores and Abdominal Ultrasonography in Acute Appendicitis

Bhardwaj¹,

Behura²,

Mohapatra³

et al. 2023

Cureus

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Introduction Acute appendicitis is a common surgical emergency. Clinical assessment plays a major role; however, subtle clinical features in early stages and atypical presentation makes diagnosis challenging. Ultrasonography (USG) of the abdomen is a usual investigation that aids in diagnosis, however, it is operator dependent. A contrast-enhanced computed tomography (CECT) of the abdomen is more accurate; however, it exposes the patient to hazardous radiation. The study aimed to combine clinical assessment and USG abdomen in the reliable diagnosis of acute appendicitis. Objectives The objective of this study was to assess the diagnostic reliability of the Modified Alvarado Score and ultrasonography of the abdomen in acute appendicitis. Material and methods All patients with right iliac fossa pain, clinically suspected of having acute appendicitis, admitted to the department of general surgery, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, between January 2019 and July 2020, who gave consent were included. Clinically, Modified Alvarado Score (MAS) was calculated, after which patients were subjected to USG abdomen, where findings were noted and a sonologic score was calculated. The study group was the patients who needed appendicectomy (n=138). Operative findings were noted. Histopathological diagnosis of acute appendicitis was deemed as confirmatory in these cases and was correlated with MAS and USG scores to determine diagnostic accuracy. Results A combined clinicoradiological (MAS + USG) score of seven showed a sensitivity of 81.8% and a specificity of 100%. The specificity of score seven or above was 100%; however, the sensitivity at 81.8%. The diagnostic accuracy of the clinicoradiological was 87.5%. The negative appendicectomy rate was 4.34%, with a diagnosis of acute appendicitis being confirmed for 95.7% of patients upon histopathological examination. Conclusion The MAS and USG of the abdomen, which is an affordable and non-invasive tool, showed increased diagnostic reliability, and hence it can help reduce the use of CECT abdomen, as CECT abdomen is considered as a gold standard for confirmation or exclusion of diagnosis of acute appendicitis. Use of the combined scoring system of MAS and USG abdomen can be used as a cost-effective alternative.

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Diagnostic Challenges in Acute Appendicitis

Cited by 2 publications

References 92 publications

Retained faecolith: an avoidable complication of laparoscopic appendicectomy

Retained faecolith: an avoidable complication of laparoscopic appendicectomy

Assessment of the Diagnostic Reliability of Modified Alvarado Scores and Abdominal Ultrasonography in Acute Appendicitis

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