Cross-Sectional Study: Still Ultrasound Is The First Paradigm In The Diagnosis Of Appendicitis

Abstract

Background: Appendicitis is one of the common cause of abdominal pain and surgical emergency. The diagnosis is mainly clinical, augmented by the imaging modality in which ultrasound still is a first paradigm. This study aims to assess the accuracy of ultrasound strategy in the diagnosis of acute appendicitis. Methods: This retrospective cross-sectional validation study was conducted in General Surgery Department, Ziauddin University and Hospitals, Karachi Pakistan from 2012 to 2015 on patients who underwent Appendectomy. It concerned 200 cases of appendectomy following, prior ultrasound examination of lower right abdomen. In 126 cases ultrasonography clearly showed the acutely inflamed appendix. In 59 cases the appendix was not visualized. In15 cases ultrasound showed periappendicular fluid collection. Among 200 patients later shown in surgery to have appendicitis, ultrasonography was unequivocally positive in 114 patients (Sensitivity 95%) and 24 patients in whom appendicitis was definitely excluded according to ultrasound examination (specificity 70%). Results: The gold standard for the diagnosis of appendicitis still requires histopathological confirmation after appendicectomy. Pooled sensitivity is 95% and specificity is 70%, ultrasound still remains the first line and extremely accurate measurement in the diagnosis of acute appendicitis. Conclusion: We conclude that ultrasonography is our first line useful aid in patients referred with clinically suspected acute appendicitis. Ultrasonography has high accuracy in diagnosing acute appendicitis and reduces negative appendectomies. A non-compressible tubular structure of 7-9 mm in diameter of the appendix is the most accurate ultrasound finding. Key Words: Acute appendicitis, Histopathology, Ultrasound, Cross sectional study, Retrospective