The Value of Scoring Systems for the Diagnosis of Acute Appendicitis

Walczak, Dominik; Pawełczak, Dariusz; Żółtaszek, Agata; Jaguścik, Rajmund; Fałek, Wojciech; Czerwińska, Monika; Ptasińska, Karolina; Trzeciak, Piotr W.; Pasieka, Zbigniew

doi:10.1515/pjs-2015-0021

Cited by 11 publications

(18 citation statements)

References 5 publications

(2 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[13] Apandektomi uygulanan hastaların %20 -30'unda normal apandis saptanmaktadır. [14] Akut apandisitle karışabilen veya onu taklit eden tuba-overyal patolojiler, üriner sistem patolojileri, Ailesel Akdeniz Ateşi, Crohn hastalığı, gastrointestinal sistem perforasyonları gibi birçok patoloji mevcuttur. Olgumuzdaki gibi preperitoneal saplı lipom torsiyonuna bağlı akut karına sebep olan gangrene lipom literatürde sadece dört hastada bildirilmiştir.…”

Section: Discussionunclassified

Torsion of a preperitoneal pedunculated lipoma of anterior abdominal wall mimicking acute appendicitis

Özemir

Orhun

Bilgiç

et al. 2016

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

ÖZETLipomlar erişkinlerde adipöz dokunun en sık görülen benign tümörleridir. Vücudun heryerinde görülebilmekle beraber, karın içinde özellikle de preperitoneal bölgede nadiren saptanmaktadırlar. Genel olarak farklı patolojiler için yapılan inceleme ve ameliyat esnasında rastlantısal olarak tespit edilmelerine rağmen çok nadir olarak da lipomun kendisi akut karını taklit eden patolojilere yol açabilmektedir. Bu yazıda, akut apandisiti taklit eden bulgularla acile başvuran ve laparaskopik eksplorasyonda karın sağ alt kadranda preperitoneal yerleşimli torsiyone olmuş saplı lipom saptanan 35 yaşındaki kadın hasta literatür eşliğinde sunuldu.Anahtar sözcükler: Akut karın; karın duvarı lipomu; minimal invaziv cerrahi. GİRİŞLipomlar yağ dokusunun iyi diferansiye, kapsüllü mezenkimal tümörleridir. Klinik olarak en sık 40-60 yaş arasında bulgu verirler. Soliter veya multiple olabilen lipomlar vücudun çeşit-li bölgelerinde, nadiren de karın içinde bulunabilmektedirler. [1][2][3][4] Gastrointestinal sistemde lipomlar submukoza veya subserozal bölgede yerleşerek intusepsiyona yol açabilirler. Preperitoneal bölge saplı lipomu ise çok nadir görülmekte olup, literatürde torsiyon nedeniyle akut karın bulgusu oluşturan sadece dört vaka bildirilmiştir. [5][6][7][8] Bu yazıda, karın sağ alt kadranda akut apandisiti taklit eden karın ağrısı bulguları ile acil servise başvuran ve tanısal laparaskopi sonucu karın sağ alt kadranda preperitoneal saplı lipom torsiyonu saptanan hasta sunuldu. OLGU SUNUMU OLGU SUNUMUOtuz beş yaşında kadın hasta, yaklaşık iki gün önce başlayan karın sağ alt kadran ağrısının artması üzerine acil polikliniği-mize başvurdu. Özgeçmişinde özellik olmayan hastanın muayenesinde akut apandisit ile uyumlu olacak şekilde karın sağ alt kadranda hassasiyet ve rebound saptandı. Kan tahlillerinde WBC: 13.300 K/mm 3 , CRP: 4 mg/dl olarak tespit edildi. Yapı-lan karın ultrasonografisinde sağ alt kadranda, çekuma yapışık ve sınırları net ayırt edilemeyen, yaklaşık 4x2 cm boyutunda, nekroze lipom ile uyumlu lezyon saptandı. Hastaya akut karın ön tanısı ile diyagnostik laparaskopi kararı alındı. Göbekten yapılan insizyondan karbondioksit insüflasyonu sonrası 10 mm'lik trokar ile batına girildi. Eksplorasyonda karın sağ alt kadranda omentum tarafından sarılmış, çekum ön duvarına yapışık, ince bir sap ile karın ön duvar peritonuna asılı olduğu gözlenen, yüzeyi düzgün, kapsüllü, yaklaşık 4x2 cm'lik enflame ve ödemli kitle lezyonu tespit edildi (Şekil 1a, b). Suprapubik bölgeden 5 mm'lik ikinci bir trokar girildi. Kitlenin çekum ön duvarına yapıştığı ve burada enflamasyona yol açtığı görüldü. Paraçekal bölgede yaklaşık 40 cc reaksiyonel mayi saptanarak aspire edildi. Grasper yardımıyla kitlenin omentum ve çe-kumla olan yapışıklıkları ayrıştırıldı. Kitlenin karın ön duvarı peritonuna tutunduğu ince sapın etrafında dönerek torsiyone olduğu ve gangren geliştiği görüldü. Laparaskopik makas ile lezyonun sap kısmı koterize edilerek kesildi. 5 mm'lik teleskop ile suprapubik trokardan girildi ve lezyon 10 mm'lik trokardan endobag yardım...

show abstract

Section: Discussionunclassified

Torsion of a preperitoneal pedunculated lipoma of anterior abdominal wall mimicking acute appendicitis

Özemir

Orhun

Bilgiç

et al. 2016

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…The variables were obtained from the previously used clinical scoring systems for AA including Alvarado, Eskelinen, Ohmann, Tzakis, Lintula, Fenyo, RIPASA, and the Appendicitis Inflammatory Response Score (AIRS). [1,4,8] The variables in these systems were evaluated by two authors (EK and MH) and combined into a simple questionnaire comprised of 20 variables (Table 1). All nominal and categorical variables were dichotomized based on the previous scoring systems as stated above.…”

Section: Questionnairementioning

confidence: 99%

“…The rate of diagnostic errors of AA cases still remains approximately 20%-45% despite the widespread use of imaging techniques. [1][2][3] This rate increases up to the higher levels especially in women who are in the reproductive age group, children, and elderly patients. [1,3] In most of the cases, surgical removal of the macroscopically and microscopically normal appearing appendix vermiformis is performed, resulting in unnecessary surgeries with a negative appendectomy rate of 20%-45%.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] This rate increases up to the higher levels especially in women who are in the reproductive age group, children, and elderly patients. [1,3] In most of the cases, surgical removal of the macroscopically and microscopically normal appearing appendix vermiformis is performed, resulting in unnecessary surgeries with a negative appendectomy rate of 20%-45%. [1,4] The use of ultra- there has been excellent predictive accuracy reported by the authors who developed these clinical scoring systems, the differences in the sensitivities and specificities in subsequent studies lead to the uncertainty of the scoring systems' reliability.…”

Section: Introductionmentioning

confidence: 99%

“…[1,3] In most of the cases, surgical removal of the macroscopically and microscopically normal appearing appendix vermiformis is performed, resulting in unnecessary surgeries with a negative appendectomy rate of 20%-45%. [1,4] The use of ultra- there has been excellent predictive accuracy reported by the authors who developed these clinical scoring systems, the differences in the sensitivities and specificities in subsequent studies lead to the uncertainty of the scoring systems' reliability. [3,[9][10][11] It has been thought that if these scoring systems were applied to the populations in which they were originally created, the diagnostic accuracy increases.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is it beneficial to use clinical scoring systems for acute appendicitis in adults?

Köse¹,

Hasbahçeci

Aydın³

et al. 2018

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

BACKGROUND: Clinical scoring systems have been used to reduce negative appendectomy rate for several decades. However, the use of these systems has been questioned due to differences in their diagnostic accuracies. The aim of this prospective study was to develop a new clinical scoring system using a combination of all previously described variables for the diagnosis of acute appendicitis (AA). METHODS:Consecutive patients who underwent emergency appendectomy for AA between December 2016 and April 2017 were prospectively included in the study. During admission, a prepared questionnaire including variables obtained from the previously used clinical scoring systems was administered. Histopathological analysis was regarded as the main outcome. Patients with no histopathological evidence of AA were defined as negative appendectomy. All variables were analyzed separately to assess their association with AA. A receiver operating characteristic curve with area under curve analysis was performed to obtain the cut-off values for numerical variables. RESULTS:There were 200 patients with a mean age of 30.8±12.8 years with a negative appendectomy rate of 5.5%. There was no significant association between the variables and the detection of histologically proven AA except increased white blood cell count >11.05/mm 3 and proportion of the polymorphonuclear leukocytes >71.2% (p=0.003 and p=0.015, respectively). CONCLUSION:The present study shows that the development and/or use of scoring systems does not significantly improve the diagnostic accuracy of AA.

show abstract

Comparing the diagnostic accuracy of modified RIPASA and MASS in patients diagnosed with acute appendicitis in Suez Canal University Hospital Emergency Department: a cross-sectional study

et al. 2022

View full text Add to dashboard Cite

Introduction Acute appendicitis is the most common surgical condition presented in emergency departments globally. It is also the most common cause of abdominal pain treated surgically, with a lifetime risk of 7%. Recent studies show MASS to be easy, simple and cheap diagnostic tool for supporting the diagnosis of acute appendicitis.The modified RIPASA scoring system includes more parameters than MASS and the latter did not contain certain parameters. These parameters are shown to add to the accuracy of modified RIPASA over MASS especially in Asian population. Aim of this study The aim of the study was to improve the diagnosis of acute appendicitis in order to lower the negative appendectomy rates. Patients & methods This is cross sectional study, the study included 40 patients presented to the emergency department at Suez Canal University hospital with abdominal pain and suspected clinically as acute appendicitis. Then the decision of surgical intervention was made by surgeons, who were blinded for our study, based on their clinical judgment. Then both scores were calculated for all patients and other clinical data were obtained from patients after accepting being included in our study with an informed consent.After operations, the operating theatre records were obtained and cases pathological investigation of the appendices was done. Then the sensitivity, specificity, positive and negative predictive values were calculated and so the diagnostic accuracy for both scoring systems. Results Clinically, all the patients were suffering acute right iliac fossa tenderness (100%), rebound tenderness (90%), and nausea/ vomiting (70%). Only 45% had elevated White blood count and 55% had negative urine analysis. Histopathological analysis of appendices of the studied patients showed that 40% of the patients had suppurative appendicitis, one quarter of them had catarrhal appendicitis and only 20% had complicated perforated appendicitis. Meanwhile, about 15% had normal (negative) appendix. Modified RIPASA showed a good discriminative ability in our study where the area under the curve for modified RIPASA was 0.902 (95% CI: 0.798 – 1.00) (p = 0.002). Moreover, a value of 8.5 or higher was found to be the best cut-off point to predict acute appendicitis among patient suspected clinically as acute appendicitis with sensitivity = 70.6%, specificity = 100%, positive predictive value of 100%, and negative predictive value of 37.5% and 75% accuracy.The best cut-off score to diagnose acute appendicitis in our sample based on MASS was fixed at 5.5, where the sensitivity of the MASS reached 47.1%, with specificity of 33.3%, positive predictive value of 80%, negative predictive value of 10% and accuracy 45%. Conclusion The modified RIPASA score is the best diagnostic scoring system for acute appendicitis if compared to the modified Alvarado score, with the former achieving significantly higher sensitivity and diagnostic accuracy. Modified RIPASA was concluded to be a more applicable and useful score. Negative appendicectomy rates can also be avoided by using modified RIPASA score.

show abstract

The Value of Scoring Systems for the Diagnosis of Acute Appendicitis

Cited by 11 publications

References 5 publications

Torsion of a preperitoneal pedunculated lipoma of anterior abdominal wall mimicking acute appendicitis

Torsion of a preperitoneal pedunculated lipoma of anterior abdominal wall mimicking acute appendicitis

Is it beneficial to use clinical scoring systems for acute appendicitis in adults?

Comparing the diagnostic accuracy of modified RIPASA and MASS in patients diagnosed with acute appendicitis in Suez Canal University Hospital Emergency Department: a cross-sectional study

Contact Info

Product

Resources

About