Publication:

A clinicopathology study to establish the accuracy of diagnosis of acute appendicitis in case of acute right lower quadrant pain of abdomen

Background Acute appendicitis, one of the most common surgical emergency is also one of the most challenging surgical dilemma for every surgeon, both in diagnosis and treatment. A negative exploration on one hand has to be weighed against the risk of subsequent perforation during expectant management especially in doubtful cases. We conducted a study to find out if diagnosis by scoring systems and graded ultrasonography improves clinical outcomes for patients with suspected appendicitis.

Methods It was a prospective and observational study including 52 patients of clinically suspected acute appendicitis presenting in the surgical emergency. All patients underwent clinical scoring using Alvarado scores and Ohmann’s score and Ultrasonography. Later, based on the intra operative findings and histopathological diagnosis of acute appendicitis, the sensitivity, specificity, positive predictive value and negative predictive value were calculated individually and by combining the scoring systems and imaging together.

Results The sensitivity, specificity, PPV and NPV of ultrasonography when combined with scoring systems (both Alvarado and Ohmann’s) is increased significantly as compared to when used individually for diagnosis of acute appendicitis. As calculated by our study, the sensitivity of USG was 90.32%, specificity 80.95%, PPV 87.5%, NPV 85% and diagnostic accuracy of 86.54% which has been comparable with the other studies in the previous literature.

Conclusions Combination of scoring systems with Ultrasonography leads to the prompt diagnosis and early treatment of many cases of appendicitis. Hence, improving clinical outcomes in doubtful cases.