Acute Appendicitis: Clinical Laboratory, Laparoscopic, Pathomorphological Parallels

Abstract

Introduction.Acute appendicitis takes the first place in incidence among acute surgical disorders of the abdominal cavity organs. While many issues of the diagnosis and treatment strategy of this disease have been studied in detail, the diagnosis of acute appendicitis remains primarily a matter of clinical presentation. National guidelines on acute appendicitis also recommend additional methods for a number of stipulated situations; these methods include the Alvarado score. The key goal of this study is to analyse the results of using the Alvarado score in the diagnosis of acute appendicitis and juxtaposing these results with the laparoscopic and pathomorphological data.Materials and methods.This non-randomised prospective study presents the analysis of examination and treatment of 4,941 patients with acute appendicitis from the two periods — from 2006 to 2010 and from 2011 to 2015 — which is before and after the Alvarado score was introduced into the examination protocol. The likelihood of acute appendicitis according to the Alvarado score is evaluated as follows. A score of one to four is interpreted as appendicitis is unlikely; a score of five or six — acute appendicitis is possible, further dynamic observation is required; a score of seven to ten indicates a most probable acute appendicitis.Results and discussion.The total sensitivity of the scoring system exceeded 90%; however, it did not result in a reduction of the number of diagnostic laparoscopies.Conclusion. The authors see as the upsides of the use of the Alvarado score the improvement of the diagnostic precision and the reduced incidence of catarrhal appendicitis (down to 0.1%) and gangrenous forms of appendicitis (from 14.6% to 8.9%) due to a shorter observation period. The authors explain the failure to achieve the result planned by the healthcare funding costs and the drive to obtain a more precise diagnosis.