Acute appendicitis is still a clinical diagnosis

Abstract EN

Objectives : Acute appendicitis is still the most common indication for emergency abdominal surgery with a life-time prevalence of 12 % for men and 25 % for women.

Diagnoses can be made by well-established clinical manifestations, but presentation can be atypical or mimic other conditions.

Diagnosis is best in young adult males and considerably poorer at extremes of age with a negative appendectomy rate of (5 %–22 %) and (30 %–46 %), respectively.

In equivocal cases supplementary investigations are needed to aid diagnosis. Aim : To compare the relative effectiveness of clinical assessment and ultrasound imaging in the diagnosis of acute appendicitis, and their effect on negative appendectomy rate. Methods : This is a prospective study of 720 patients with clinical suspicion of acute appendicitis who were admitted to the emergency department at Al Bashir Teaching Hospital from April 2009 to December 2012.

Ultrasound was performed in 350 patients, while clinical evaluation was the main means of diagnosis of acute appendicitis in the remaining 370 patients. Data was collected for : age, gender, signs and symptoms, white blood cell count, ultrasound findings, histopathology and length of hospital stay. Results : The mean age was 29.25 years, with female / male ratio of 198 / 152 and 208 / 162 for the ultrasound and clinical groups respectively.

Periumbilical pain which shifted to right iliac fossa was the predominant complaint.

Patients evaluated by ultrasound have a sensitivity and specificity of 75 % and 83 % respectively, with a negative appendectomy rate of 19.4 %, P value > 0.05 % ; while patients evaluated by clinical exam alone have a sensitivity and specificity of 84 % and 71 % respectively, with a negative appendectomy rate of 18.4 %, P value > 0.05 %.

The length of hospital stay was 2.1 days and 2.6 days for the ultrasound and clinical groups respectively. Conclusion : Diagnosis of acute appendicitis is still difficult though it can be made by an experienced surgeon with proper history and good clinical examination supported by simple investigations: like white blood cell count.

Routine use of ultrasound for diagnosis is not recommended, except for equivocal cases.

Investigations should not replace the skills of a general surgeon.