Skip to main content

Advertisement

SpringerLink
Log in

The role of preoperative graded compression ultrasound in detecting acute appendicitis and influencing the negative appendectomy rate

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The diagnosis of acute appendicitis is mainly clinical and is correct in about 80% of patients, but 20–33% present with atypical findings, which resulted in a negative appendectomy rate of 20–30%. The graded compression ultrasound method in the diagnosis of acute appendicitis was reported with a sensitivity of 89%, and specificity of 95%. In this study, we aim to evaluate the graded compression ultrasonography in the diagnosis of acute appendicitis, its influence on the clinical judgment to operate, and its role in lowering the negative appendectomy rate.

Methods

1073 patients treated surgically for acute appendicitis between January 2005 and December 2014 were reviewed. Ultrasound findings, histopathological diagnosis, and positive or negative appendectomy rates were analyzed.

Results

647 (60.3%) patients were males and 426 (39.7%) females. The mean age was 26.5 years. Positive ultrasound findings were recorded in 892 (83.13%), while negative findings were recorded in 181 (16.87%). Positive appendectomy was recorded in 983 (91.6%), while negative appendectomy was recorded in 90 (8.4%). The sensitivity was 83%, specificity was 100%, and the rate of negative appendectomy was 8.39%.

Conclusion

Graded compression technique of ultrasound is a useful modality, in addition to the clinical judgment of the surgeon and clinical findings, in detecting true positive cases of acute appendicitis, and thus reducing the negative appendectomy rate. Values of 100% specificity, and 8.4% negative appendectomy rate, or better, could be achieved, when an experienced surgeon and a professional radiologist collaborate in the diagnosis of acute appendicitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Shirah BH, Shirah HA (2016) Wound infection in non-perforated acute appendicitis- single dose preoperative antibiotics vs. prophylactic postoperative antibiotics: does it make any difference? Int J Res Med Sci 4(1):225–230

    Article  Google Scholar 

  2. Shelton T, Mckinlay R, Schwartz RW (2003) Acute appendicitis: current diagnosis and treatment. Curr Surg 60(5):502–505

    Article  PubMed  Google Scholar 

  3. Mostbeck G, Adam EJ, Nielsen MB, et al. (2016) How to diagnose acute appendicitis: ultrasound first. Insights Imaging 7(2):255–263

    Article  PubMed  PubMed Central  Google Scholar 

  4. Topin F, Thierry AL, Catrevaux O, et al. (2016) Diagnostic accuracy of emergency physician-performed ultrasound for acute appendicitis in a remote location. J Emerg Med 50(6):859–867

    Article  PubMed  Google Scholar 

  5. Shirah BH, Shirah HA, Alhaidari WA (2016) Perforated appendix—delay in presentation rather than delay in the surgical intervention: retrospective database analysis of 2573 saudi arabian patients in 10 years. Int J Sci Stud 4(1):32–36

    Google Scholar 

  6. Power D (2015) Pitfalls in the diagnosis of appendicitis. Practitioner 259(1787):33

    PubMed  Google Scholar 

  7. Puylaert JB (1986) Acute appendicitis: US evaluation using graded compression. Radiology 158(2):355–360

    Article  CAS  PubMed  Google Scholar 

  8. Chesbrough RM, Burkhard TK, Balsara ZN, Goff WB, Davis DJ (1993) Self-localization in US of appendicitis: an addition to graded compression. Radiology 187(2):349–351

    Article  CAS  PubMed  Google Scholar 

  9. Lim HK, Lee WJ, Kim TH, et al. (1996) Appendicitis: usefulness of color Doppler US. Radiology 201(1):221–225

    Article  CAS  PubMed  Google Scholar 

  10. Jeffrey RB, Laing FC, Lewis RF (1987) Acute appendicitis: high-resolution real-time US findings. Radiology 163:11–14

    Article  PubMed  Google Scholar 

  11. Bouyou J, Gaujoux S, Marcellin L, et al. (2015) Abdominal emergencies during pregnancy. J Visc Surg 152(6 Suppl):S105–S115

    Article  CAS  PubMed  Google Scholar 

  12. Ramalingam V, Lebedis C, Kelly JR, et al. (2015) Evaluation of a sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female. Emerg Radiol 22(2):125–132

    Article  PubMed  Google Scholar 

  13. Khairy G (2009) Acute appendicitis: is removal of a normal appendix still existing and can we reduce its rate? Saudi J Gastroenterol 15(3):167–170

    Article  PubMed  PubMed Central  Google Scholar 

  14. Althoubaity FK (2006) Suspected acute appendicitis in female patients trends in diagnosis in emergency department in a university hospital in Western Region of Saudi Arabia. Saudi Med J 27:1667–1673

    PubMed  Google Scholar 

  15. Wade DS, Marrow SE, Balsara ZN, Burkhard TK, Goff WB (1993) Accuracy of ultrasound in the diagnosis of acute appendicitis compared with the surgeon’s clinical impression. Arch Surg 128(9):1039–1044

    Article  CAS  PubMed  Google Scholar 

  16. Nasiri S, Mohebbi F, Sodagari N, Hedayat A (2012) Diagnostic values of ultrasound and the modified alvarado scoring system in acute appendicitis. Int J Emerg Med 5(1):26

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lee JH, Jeong YK, Hwang JC, Ham SY, Yang SO (2002) Graded compression sonography with adjuant use of posterior compression technique in the sonographic diagnosis of acute appendicitis. AJR Am J Roentgenol 178(4):863–868

    Article  PubMed  Google Scholar 

  18. Puig S, Hörmann M, Rebhandl W, et al. (2003) US as a primary diagnostic tool in relation to negative appendectomy: six years experience. Radiology 226(1):101–104

    Article  PubMed  Google Scholar 

  19. Myers E, Kavanagh DO, Ghous H, Evoy D, McDermott EW (2010) The impact of evolving management strategies on negative appendicectomy rate. Colorectal Dis 12(8):817–821

    Article  CAS  PubMed  Google Scholar 

  20. Park JS, Jeong JH, Lee JI, et al. (2013) Accuracies of diagnostic methods for acute appendicitis. Am Surg 79(1):101–106

    PubMed  Google Scholar 

  21. Corso F (1994) Laparoscopic appendectomy. Int Surg 79:247–250

    CAS  PubMed  Google Scholar 

  22. Grunewald B, Keating J (1993) Should the ‘normal’ appendix be removed at operation for appendicitis? J R Coll Surg Edinb 38(3):158–160

    CAS  PubMed  Google Scholar 

  23. Chandrasegaram MD, Rothwell LA, An EI, Miller RJ (2012) Pathologies of the appendix: a 10-year review of 4670 appendicectomy specimens. ANZ J Surg 82(11):844–847

    Article  PubMed  Google Scholar 

  24. Cox TC, Huntington CR, Blair LJ, et al. (2016) Laparoscopic appendectomy and cholecystectomy versus open: a study in 1999 pregnant patients. Surg Endosc 30(2):593–602

    Article  CAS  PubMed  Google Scholar 

  25. Shirah BH, Shirah HA, Alhaidari WA, Abdulbagi OE (2016) Challenges in the management of subhepatic acute appendicitis in the emergency setting. Int J Cur Res Rev 8(6):47–52

    Google Scholar 

Download references

Authors contribution

All authors have substantially contributed to the paper. HAS and WAA conducted the clinical part of the study. MAE and MAC participated in the radiological part of the study. BHS wrote, edited the manuscript, and analyzed the clinical data. All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, P.O.Box 65362, Jeddah, 21556, Saudi Arabia

    Bader Hamza Shirah

  2. Department of General Surgery, Al Ansar General Hospital, Medina, Saudi Arabia

    Hamza Asaad Shirah

  3. Department of Accidents and Emergency, Al Ansar General Hospital, Medina, Saudi Arabia

    Wael Awad Alhaidari

  4. Department of Radiology, Al Ansar General Hospital, Medina, Saudi Arabia

    Mohamed Ali Elraghi & Mohammad Azam Chughtai

Authors
  1. Bader Hamza Shirah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hamza Asaad Shirah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wael Awad Alhaidari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed Ali Elraghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohammad Azam Chughtai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bader Hamza Shirah.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shirah, B.H., Shirah, H.A., Alhaidari, W.A. et al. The role of preoperative graded compression ultrasound in detecting acute appendicitis and influencing the negative appendectomy rate. Abdom Radiol 42, 109–114 (2017). https://doi.org/10.1007/s00261-016-0862-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-016-0862-0

Keywords

Search

Navigation