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.
Similar content being viewed by others
References
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
Shelton T, Mckinlay R, Schwartz RW (2003) Acute appendicitis: current diagnosis and treatment. Curr Surg 60(5):502–505
Mostbeck G, Adam EJ, Nielsen MB, et al. (2016) How to diagnose acute appendicitis: ultrasound first. Insights Imaging 7(2):255–263
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
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
Power D (2015) Pitfalls in the diagnosis of appendicitis. Practitioner 259(1787):33
Puylaert JB (1986) Acute appendicitis: US evaluation using graded compression. Radiology 158(2):355–360
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
Lim HK, Lee WJ, Kim TH, et al. (1996) Appendicitis: usefulness of color Doppler US. Radiology 201(1):221–225
Jeffrey RB, Laing FC, Lewis RF (1987) Acute appendicitis: high-resolution real-time US findings. Radiology 163:11–14
Bouyou J, Gaujoux S, Marcellin L, et al. (2015) Abdominal emergencies during pregnancy. J Visc Surg 152(6 Suppl):S105–S115
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
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
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
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
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
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
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
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
Park JS, Jeong JH, Lee JI, et al. (2013) Accuracies of diagnostic methods for acute appendicitis. Am Surg 79(1):101–106
Corso F (1994) Laparoscopic appendectomy. Int Surg 79:247–250
Grunewald B, Keating J (1993) Should the ‘normal’ appendix be removed at operation for appendicitis? J R Coll Surg Edinb 38(3):158–160
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
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
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
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
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-016-0862-0