Does abdominal ultrasound is a useful tool in appendicitis diagnosis?
Languages of publication
Introduction: Acute appendicitis is the most common acute abdominal illness. Despite progress in diagnosis, there is still a 20% negative appendectomy rate. The aim of the study was to determine the usefulness of abdominal sonography in the diagnosis of acute appendicitis. Materials and methods: Data were collected retrospectively from 326 patients operated with suspected appendicitis, who had undergone abdominal ultrasound prior to surgery. Appendicitis was confirmed by pathology reports. There were two variants of positive abdominal sonography. In the first, positive ultrasound was visualized inflamed appendix. In the second variant, the sonographic diagnosis of appendicitis was based on a visualized inflamed appendix or one of indirect signs of appendicitis – localized periappendiceal fluid collection, enlarged lymph nodes, thickening of the intestinal wall in the right iliac fossa. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were defined and compared. Results: 83.74% patients have appendicitis in their pathologic report. In 39.53% cases, the appendix was visualized via abdominal ultrasound. In 65.95% cases of sonography, there occurred indirect signs. In the first variant, sensitivity, specificity, PPV and NPV amounted to 47.99%, 79.25%, 92.25% and 22.83%, respectively. In the second variant, they amounted to 67.77%, 43.40%, 86.05% and 20.72%, respectively. In the second variant, sensitivity was significantly higher (p<0.001), however specificity was significantly lower (p<0.001). Conclusion: Limited sensitivity and specificity cannot be a confirmation of appendicitis. The typical clinical course with a negative ultrasound should not delay correct diagnosis and early surgical treatment.
Publication order reference