Comparison of Radiologic Diagnosis with surgical findings in 900 pts of acute appendicitis at AIMH, Sialkot

Abstract

Aim: To compare the radiological diagnosis with surgical findings of acute appendicitis Methods: This study included patients presenting with the complaint of pain in the right iliac fossa suggestive of acute appendicitis. The criteria for inclusion; twelve to sixty-five years of age, the existence of pain in the abdomen especially right iliac fossa or lower quadrant. Patients who presented with shock were excluded. Subjects suspected of acute appendicitis were referred for ultrasonography, which was carried out by a senior radiologist. A linear and convex probe was used for ultrasonography. Patients with insignificant findings on ultrasonography were evaluated for pain in the lower right quadrant. Those with ultra-sonographic findings strongly suggestive of acute appendicitis underwent a further evaluation to rule out complications. Results: Our study is based on 900 patients who fulfilled criteria of inclusion, age ranged from 6-55 years (mean 35±6.9 years) male to female ratio (2.22:1), 1036 ultrasonographic scans were done in these patients, 964 urine routine examination. The radiological confirmation of acute appendicitis 723, while clinical diagnosis of 900 patients leading to operative intervention. Laparoscopic appendectomy was done in 288 patients while open surgery in 612 patients. Histopathology of specimen of all the patients were obtained. In sonographic findings, appendix was visualized in 723 (80.33%) patients, uncompressible tubular structure in 723(80.33%), fluid in right iliac region 118(13.11%), mesenteric node enlargement in 103(11.44%), high up subhepatic appendix in 23(2.55%), and mass formation in 24(2.66%) patients. The surgical operative findings in the patients are as: hyperemic swollen appendix 648(72%), Blackened/ gangrenous appendix 84(9.33%), Appendix with pus in surrounding area 57(6.33%), appendix swollen with enlarged mesenteric lymph nodes 210(23.33%), Perforated appendix 58(6.44%), Early mass formation 35(3.88%) and Subhepatic appendix 23(2.55%). Conclusion: Ultrasonography being non invasive investigation is advised to diagnosis appendicitis. It has optimal sensitivity and for its diagnosis and suitable diagnostic method for assessing complications of appendicitis. The false negative diagnosis at ultrasonography for acute appendicitis is quantified as 14.44% with accuracy or sensitivity of 85.46%. Keywords: Appendicitis, incompressible, tubular structure, clinical diagnosis.