The Role of Ultrasound in the Diagnosis of Acute Appendicitis: A Prospective Study

Abstract

Background: Misdiagnosis of acute appendicitis is a common and crucial problem in general surgery, as the mortality and morbidity increase from 3 – 15 folds, if appendix gets perforated. Graded compression ultrasonography is one of the new diagnostic techniques that are reported to improve the diagnostic accuracy and clinical outcome. The aim of current study is to assess the diagnostic accuracy of ultrasound in the diagnosis of suspected acute appendicitis. Methods: One hundred-eighty patients admitted to the general surgical ward at Al Kindy Teaching Hospital from 1 June 2019 to 28 Feb. 2020. All patients complaining of right iliac fossa pain and tenderness with a suspension of acute appendicitis, a clinical assessment done for them by using modified ALVARADO SCORE (only 5 and below was taken). All patients subjected to do routine WBC count and urine investigations. When the diagnosis of acute appendicitis was clinically equivocal, an abdominal ultrasound was performed to all patients within Four hours of admission. A dilated, Non- compressible appendix greater than 6 mm diameter, and edema and a symmetry of the appendicular wall where considered positive for acute appendicitis. A normal appendix on pathology was considered false positive. Results: Out of 180 cases, operated upon on clinical ground (Alvarado 5 and below), ultrasound done to all of them and findings according to histopathology were: True positive (160) True negative (14), False positive (1) False negative (5)cases. Ultrasonography yielded a sensitivity rate 96% and specificity rate 93%. Conclusion: Ultrasound by graded compression technique provides highly accurate, sensitive and specific test for clinically equivocal acute appendicitis