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Coratti F, Vannuccini S, Foppa C, Staderini F, Coratti A, Cianchi F, Petraglia F. Emergency surgery for appendectomy and incidental diagnosis of superficial peritoneal endometriosis in fertile age women. Reprod Biomed Online 2020; 41:729-733. [PMID: 32807657 DOI: 10.1016/j.rbmo.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/19/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION This study aimed to evaluate the presence of superficial peritoneal endometriosis (SUP) in women referred to emergency surgery for right iliac fossa (RIF) pain and undergoing an appendectomy, considering which factors may be useful to suspect and identify endometriosis. DESIGN An observational case-control study was conducted on a group (n = 149) of fertile age women. After surgery, Group A was selected upon the diagnosis of endometriosis (n = 34); Group B (n = 115) represented the controls. Demographics, comorbidities and clinical findings were registered and analysed. RESULTS Appendicitis of various grades of severity was diagnosed in all patients, but SUP was also identified in 23%, of which 14.7% also presented with endometriosis of the appendix. Women in Group A reported chronic pelvic pain, dysmenorrhoea, dyspareunia and oral contraceptive use more frequently. At multivariate analysis, factors associated with endometriosis were: age <40 years, autoimmune disorders, multiple allergies, abdominal chronic pain, associated gynaecological pain symptoms, Alvarado score ≤6, and inconclusive ultrasound findings. CONCLUSIONS The incidental finding of SUP in fertile age women presenting with an acute RIF pain and undergoing emergency surgery is a relevant observation. Clinical history and symptoms should guide surgeons in performing a correct diagnosis and in referring the patient to the gynaecology specialist.
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Affiliation(s)
- Francesco Coratti
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Silvia Vannuccini
- Department of Molecular and Developmental Medicine, University of Siena Siena, Italy; Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital Florence, Italy
| | - Caterina Foppa
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Fabio Staderini
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Andrea Coratti
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital Florence, Italy.
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Hajalioghli P, Mostafavi S, Mirza-Aghazadeh-Attari M. Ultrasonography in diagnosis of appendicitis and its complications in pediatric patients: a cross-sectional study. ANNALS OF PEDIATRIC SURGERY 2020. [DOI: 10.1186/s43159-020-00023-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Appendicitis is a common cause of acute abdomen in pediatrics. Although various criteria have been suggested in early diagnosis of appendicitis, these criteria are not as applicable for pediatric patients. Because of this, imaging has an important role in the diagnosis of appendicitis in pediatric patients. The present study was conducted on 121 pediatric patients with possible diagnosis of appendicitis. All of the patients underwent initial evaluation and then underwent sonographic imaging. Sonography was used to assess the existence of signs associated with appendicitis, or its complications. Imaging findings were compared in patients with complications with those with complications. True false positive, false negative, true positive, and true negative values were calculated. Sensitivity and specificity of ultrasonography in determining appendicitis was evaluated.
Results
The mean age of children was 8.08 ± 3.25 years, with ages ranging from 3 to 14 years. Of the 121 children, 74(61.2%) were male and 47(38.8%) were female. In total, there were 3(2.4%) false positives and 2(1.6%) false negatives based on sonographic findings. There were also 54(44.6%) true positive and 62(51.2%) true negative based on sonographic findings. Based on the findings of ultrasound in this study, ultrasound sensitivity was 96.4%, specificity was 95.3%, positive predictive value was 94.7%, and negative predictive value was 96.8%.
Conclusion
Ultrasonography is indicated in the diagnosis of appendicitis in pediatric patients and has optimal sensitivity and specificity in the diagnosis. Furthermore, it is a suitable diagnostic method for evaluating complications of appendicitis.
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Rud B, Vejborg TS, Rappeport ED, Reitsma JB, Wille‐Jørgensen P. Computed tomography for diagnosis of acute appendicitis in adults. Cochrane Database Syst Rev 2019; 2019:CD009977. [PMID: 31743429 PMCID: PMC6953397 DOI: 10.1002/14651858.cd009977.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Diagnosing acute appendicitis (appendicitis) based on clinical evaluation, blood testing, and urinalysis can be difficult. Therefore, in persons with suspected appendicitis, abdominopelvic computed tomography (CT) is often used as an add-on test following the initial evaluation to reduce remaining diagnostic uncertainty. The aim of using CT is to assist the clinician in discriminating between persons who need surgery with appendicectomy and persons who do not. OBJECTIVES Primary objective Our primary objective was to evaluate the accuracy of CT for diagnosing appendicitis in adults with suspected appendicitis. Secondary objectives Our secondary objectives were to compare the accuracy of contrast-enhanced versus non-contrast-enhanced CT, to compare the accuracy of low-dose versus standard-dose CT, and to explore the influence of CT-scanner generation, radiologist experience, degree of clinical suspicion of appendicitis, and aspects of methodological quality on diagnostic accuracy. SEARCH METHODS We searched MEDLINE, Embase, and Science Citation Index until 16 June 2017. We also searched references lists. We did not exclude studies on the basis of language or publication status. SELECTION CRITERIA We included prospective studies that compared results of CT versus outcomes of a reference standard in adults (> 14 years of age) with suspected appendicitis. We excluded studies recruiting only pregnant women; studies in persons with abdominal pain at any location and with no particular suspicion of appendicitis; studies in which all participants had undergone ultrasonography (US) before CT and the decision to perform CT depended on the US outcome; studies using a case-control design; studies with fewer than 10 participants; and studies that did not report the numbers of true-positives, false-positives, false-negatives, and true-negatives. Two review authors independently screened and selected studies for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently collected the data from each study and evaluated methodological quality according to the Quality Assessment of Studies of Diagnostic Accuracy - Revised (QUADAS-2) tool. We used the bivariate random-effects model to obtain summary estimates of sensitivity and specificity. MAIN RESULTS We identified 64 studies including 71 separate study populations with a total of 10,280 participants (4583 with and 5697 without acute appendicitis). Estimates of sensitivity ranged from 0.72 to 1.0 and estimates of specificity ranged from 0.5 to 1.0 across the 71 study populations. Summary sensitivity was 0.95 (95% confidence interval (CI) 0.93 to 0.96), and summary specificity was 0.94 (95% CI 0.92 to 0.95). At the median prevalence of appendicitis (0.43), the probability of having appendicitis following a positive CT result was 0.92 (95% CI 0.90 to 0.94), and the probability of having appendicitis following a negative CT result was 0.04 (95% CI 0.03 to 0.05). In subgroup analyses according to contrast enhancement, summary sensitivity was higher for CT with intravenous contrast (0.96, 95% CI 0.92 to 0.98), CT with rectal contrast (0.97, 95% CI 0.93 to 0.99), and CT with intravenous and oral contrast enhancement (0.96, 95% CI 0.93 to 0.98) than for unenhanced CT (0.91, 95% CI 0.87 to 0.93). Summary sensitivity of CT with oral contrast enhancement (0.89, 95% CI 0.81 to 0.94) and unenhanced CT was similar. Results show practically no differences in summary specificity, which varied from 0.93 (95% CI 0.90 to 0.95) to 0.95 (95% CI 0.90 to 0.98) between subgroups. Summary sensitivity for low-dose CT (0.94, 95% 0.90 to 0.97) was similar to summary sensitivity for standard-dose or unspecified-dose CT (0.95, 95% 0.93 to 0.96); summary specificity did not differ between low-dose and standard-dose or unspecified-dose CT. No studies had high methodological quality as evaluated by the QUADAS-2 tool. Major methodological problems were poor reference standards and partial verification primarily due to inadequate and incomplete follow-up in persons who did not have surgery. AUTHORS' CONCLUSIONS The sensitivity and specificity of CT for diagnosing appendicitis in adults are high. Unenhanced standard-dose CT appears to have lower sensitivity than standard-dose CT with intravenous, rectal, or oral and intravenous contrast enhancement. Use of different types of contrast enhancement or no enhancement does not appear to affect specificity. Differences in sensitivity and specificity between low-dose and standard-dose CT appear to be negligible. The results of this review should be interpreted with caution for two reasons. First, these results are based on studies of low methodological quality. Second, the comparisons between types of contrast enhancement and radiation dose may be unreliable because they are based on indirect comparisons that may be confounded by other factors.
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Affiliation(s)
- Bo Rud
- Copenhagen University Hospital HvidovreGastrounit, Surgical DivisionKettegaards Alle 30HvidovreDenmark2650
| | - Thomas S Vejborg
- Bispebjerg Hospital, University of CopenhagenDepartment of Radiology R23 Bispebjerg BakkeCopenhagenDenmarkDK 2400 NV
| | - Eli D Rappeport
- Bispebjerg Hospital, University of CopenhagenDepartment of Radiology R23 Bispebjerg BakkeCopenhagenDenmarkDK 2400 NV
| | - Johannes B Reitsma
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CarePO Box 85500UtrechtNetherlands3508 GA Utrecht
| | - Peer Wille‐Jørgensen
- Bispebjerg HospitalDepartment of Surgical Gastroenterology KBispebjerg Bakke 23Copenhagen NVDenmarkDK‐2400
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Msolli MA, Beltaief K, Bouida W, Jerbi N, Grissa MH, Boubaker H, Boukef R, Nouira S. Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis. BMC Emerg Med 2018; 18:15. [PMID: 29793425 PMCID: PMC5968536 DOI: 10.1186/s12873-018-0166-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/15/2018] [Indexed: 11/12/2022] Open
Abstract
Background The aim of this study is to test the diagnostic value of baseline and early change of C-reactive protein (CRP) concentrations, evaluated separately or in combination with the modified Alvarado score (MAS), in patients with clinically suspected acute appendicitis. Methods This is a prospective observational study including all patients presenting to the emergency department with an equivocal diagnosis of acute appendicitis. After inclusion, clinical and demographic data are recorded and blood samples were taken at baseline and 3 h after for serum CRP measurements (3 h CRP). The MAS is also calculated for all patients. The ultimate diagnosis of appendicitis was based on the histologic findings of the excised appendix in operated patients and clinical follow-up in emergency department discharged patients. Diagnostic accuracy of admission CRP, early change of CRP 3 h CRP minus admission CRP, MAS and the combination of these parameters was expressed by sensitivity, specificity, positive predictive value, negative predictive value and area under receiver operating characteristics curve. Results Five hundred patients were included from January 2010 to December 2013. Overall, 387 patients were operated the negative appendectomy rate was 8,3%. CRP concentrations were higher in patients with acute appendicitis. However, the diagnostic value of admission CRP, delta CRP and MAS was moderate with area under ROC curve respectively equal to 0.63, 0.53 and 0.6. Combining admission CRP and delta CRP values to MAS did not result in a better performance. The area under ROC curve did not exceed 0.7 with the different combinations. Conclusion Early change of CRP has a moderate diagnostic value in patients with clinically suspected acute appendicitis. Combining CRP values to MAS did not improve diagnostic accuracy.
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Affiliation(s)
- Mohamed Amine Msolli
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia. .,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia.
| | - Kaouther Beltaief
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Wahid Bouida
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Nahla Jerbi
- Emergency Department, Mahdia University Hospital, 5100, Mahdia, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
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Jamshidnezhad A, Azizi A, Zadeh SR, Shirali S, Shoushtari MH, Sabaghan Y, Ziagham V, Attarzadeh M. A Computer Based Model in Comparison with Sonography Imaging to Diagnosis of Acute Appendicitis in Iran. J Acute Med 2017; 7:10-18. [PMID: 32995164 DOI: 10.6705/j.jacme.2017.0701.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Acute appendicitis overlaps with conditions of other diseases in terms of Symptoms and signs in the first hours of presentation. Ultrasound imaging and laboratory tests are usually used to decrease the diagnosis errors in the case of abdominal pain. However, same results may be happened using the mentioned examination tools for a string of diseases with abdominal pain. Moreover, those tests raise the medical costs for hospitals and patients. Clinical Decision Support Systems (CDSSs) can be used to assist the physicians to make the proper health care decisions particularly in the unreliable conditions. Objectives To improve the decision making process by physicians in diagnosis of acute appendicitis, an optimizing model was developed. The main objective is to discover a diagnostic model using the minimum clinical factors available in the first hours of abdominal pain. Methods Fuzzy-rule based classifier is a known technique in the Decision Support Systems (DSSs). In this article thus the useful clinical factors were explored and the diagnosis knowledge was discovered using Honey Bee Reproduction Cycle (HRBC) algorithm in the Fuzzy-rule based system. In this model, the proposed algorithm created the Fuzzy rules as the diagnosis knowledge in an optimizing process. To evaluate the accuracy of the proposed model for diagnosing of appendicitis, a collection of data was gathered from abdominal patients who referred to the educational general hospitals in Ahvaz, Iran in 2014 to 2015 years. In this process, the proposed model was optimized first in a training phase using a training dataset, and then it was tested with the testing dataset. Then, the achieved results from the computer base model were compared with ultrasound imaging findings before surgery as well as other detection methods in the previous studies. Results The comparison results illustrated that the proposed hybrid classification model as a CDSS improves considerably the accuracy of acute appendicitis diagnosis. Experimental outcomes illustrated that the proposed algorithm improves considerably the optimization performance in the diagnostic problem with the accuracy rate of 89.9%. The mentioned rate was achieved while a limited range of factors as the input parameters were used in the hybrid model. Conclusion The proposed differential diagnostic model can be used as a CDSS especially conditions in which access to costly equipment such as CT scans and Sonography tools are limited. The developed model improves the diagnosis time as well as the treatment costs for the patients with acute abdomen suspicious of acute appendicitis.
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Affiliation(s)
- Amir Jamshidnezhad
- Ahvaz Jundishapur University of Medical Sciences Department of Health Information Technology, Faculty of Allied Health Sciences Ahvaz Iran
| | - Ahmad Azizi
- Ahvaz Jundishapur University of Medical Sciences Department of Health Information Technology, Faculty of Allied Health Sciences Ahvaz Iran
| | - Sara Rekabeslami Zadeh
- Ahvaz Jundishapur University of Medical Sciences Department of Health Information Technology, Faculty of Allied Health Sciences Ahvaz Iran
| | - Saeed Shirali
- Ahvaz Jundishapur University of Medical Sciences Department of Laboratory Sciences, Faculty of Allied Health Sciences Ahvaz Iran
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McDonald RJ, Schwartz KM, Eckel LJ, Diehn FE, Hunt CH, Bartholmai BJ, Erickson BJ, Kallmes DF. The effects of changes in utilization and technological advancements of cross-sectional imaging on radiologist workload. Acad Radiol 2015. [PMID: 26210525 DOI: 10.1016/j.acra.2015.05.007] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
RATIONALE AND OBJECTIVES To examine the effect of changes in utilization and advances in cross-sectional imaging on radiologists' workload. MATERIALS AND METHODS All computed tomography (CT) and magnetic resonance imaging (MRI) examinations performed at a single institution between 1999 and 2010 were identified and associated with the total number of images for each examination. Annual trends in institutional numbers of interpreted examinations and images were translated to changes in daily workload for the individual radiologist by normalizing to the number of dedicated daily CT and MRI work assignments, assuming a 255-day/8-hour work day schedule. Temporal changes in institutional and individual workload were assessed by Sen's slope analysis (Q = median slope) and Mann-Kendall test (Z = Z statistic). RESULTS From 1999 to 2010, a total of 1,517,149 cross-sectional imaging studies (CT = 994,471; MRI = 522,678) comprising 539,210,581 images (CT = 339,830,947; MRI = 199,379,634) were evaluated at our institution. Total annual cross-sectional studies steadily increased from 84,409 in 1999 to 147,336 in 2010, representing a twofold increase in workload (Q = 6465/year, Z = 4.2, P < .0001). Concomitantly, the number of annual departmental cross-sectional images interpreted increased from 9,294,140 in 1990 to 94,271,551 in 2010, representing a 10-fold increase (Q = 8707876/year, Z = 4.5, P < .0001). Adjusting for staffing changes, the number of images requiring interpretation per minute of every workday per staff radiologist increased from 2.9 in 1999 to 16.1 in 2010 (Q = 1.7/year, Z = 4.3, P < .0001). CONCLUSIONS Imaging volumes have grown at a disproportionate rate to imaging utilization increases at our institution. The average radiologist interpreting CT or MRI examinations must now interpret one image every 3-4 seconds in an 8-hour workday to meet workload demands.
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Bon TDP, Frascari P, Moura MDA, Martins MVDDC. Comparative study between patients with acute appendicitis treated in primary care units and in emergency hospitals. Rev Col Bras Cir 2014; 41:341-4. [PMID: 25467099 DOI: 10.1590/0100-69912014005008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/25/2014] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To retrospectively analyze the relationship of time of care, combined with possible post-appendectomy complications, with the promptness of transfer of patients seen in Emergency Care Units (UPA) to the emergency hospital. METHODS We analyzed patients with preoperative diagnosis of acute appendicitis undergoing appendectomy from January to July 2012. Patients were divided into two groups according to the site of the first care. Group A included patients who received initial care directly in the emergency department of the Lourenço Jorge County Hospital (HMLJ) and group B consisted of patients seen in the UPA and forwarded to HMLJ to undergo surgical treatment. RESULTS the average time between initial treatment and surgery in group A was 29 hours (SD = 21.95) and 54 hours in group B (SD = 54.5). Considering the onset of symptoms, the patients in group A were operated on average 67 hours after (SD = 42.55), while group B, 90 hours (SD = 59.58). After the operation, patients in group A were hospitalized, on average, for 94 hours (SD = 73.53) and group B, 129 hours (SD = 193.42). CONCLUSION there was no significant difference in the time elapsed between the onset of symptoms, initial treatment and early surgical treatment, or time elapsed between surgery and discharge.
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Tasleem A, Zaman Q, Thomas DA, Payne JG, Kerwat R, Khan AA. Omental Torsion: An Unusual Cause of Right Iliac Fossa Pain and Role of Laparoscopic Management. Gastroenterology Res 2013; 6:237-239. [PMID: 27785259 PMCID: PMC5051132 DOI: 10.4021/gr299e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2013] [Indexed: 11/03/2022] Open
Abstract
Omental torsion is a rare cause of acute abdomen. It usually presents with acute onset right-sided abdominal pain. Adult male between 40 and 50 years of age and obesity are the most common risk factor amongst others. Clinical diagnosis is challenging and difficult to differentiate from more common clinical pathologies such as acute appendicitis and/or acute cholecystitis. Transabdominal imagings such as ultrasonography and/or computed tomography are useful showing typical whirl pattern. Advocated management is surgical excision of torted omentum. Herein, we report a case of primary omental torsion in an adult and a review of current literature. The diagnosis was incidental when patient was undertaken for laparoscopic appendectomy. Only the distal edge of right omentum was torted making a fatty mass of 4 × 3 cm lying on the ascending colon that could have been easily missed if open appendectomy was opted. This case not only highlights the importance of considering torted omentum in differential diagnosis of right-sided abdominal pains but also backs the changing practice to laparoscopic approach for management of right iliac fossa pain.
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Affiliation(s)
- Ali Tasleem
- Department of Surgery, Queen Mary Hospital, Sidcup, Kent DA14, UK
| | - Qamar Zaman
- Department of Surgery, Queen Mary Hospital, Sidcup, Kent DA14, UK
| | - Daniel A Thomas
- Department of Surgery, Queen Mary Hospital, Sidcup, Kent DA14, UK
| | - John G Payne
- Department of Surgery, Queen Mary Hospital, Sidcup, Kent DA14, UK
| | - Rajab Kerwat
- Department of Surgery, Queen Mary Hospital, Sidcup, Kent DA14, UK
| | - Aftab A Khan
- Department of Surgery, Queen Mary Hospital, Sidcup, Kent DA14, UK
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Longitudinal Trends in the Treatment of Abdominal Pain in an Academic Emergency Department. J Emerg Med 2013; 45:324-31. [DOI: 10.1016/j.jemermed.2013.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 10/03/2012] [Accepted: 01/18/2013] [Indexed: 11/20/2022]
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Examining the relevance of the physician's clinical assessment and the reliance on computed tomography in diagnosing acute appendicitis. Am J Surg 2013; 205:452-6. [DOI: 10.1016/j.amjsurg.2012.07.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 01/07/2023]
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Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis. World J Emerg Surg 2012; 7:27. [PMID: 22866907 PMCID: PMC3469372 DOI: 10.1186/1749-7922-7-27] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 07/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of acute appendicitis is based on careful history, physical examination, laboratory and imaging investigation. The aim of the study is to analyze the role of C-reactive protein (CRP), white blood count (WBC) and Neutrophil percentage (NP) in improving the accuracy of diagnosis of acute appendicitis and to compare it with the intraoperative assessment and histopathology findings. MATERIALS AND METHODS This investigation was a prospective double blinded clinical study. The study was done on 173 patients surgically treated for acute appendicitis. The WBC, NP, and measurement of CRP were randomly collected pre-operatively from all involved patients. Macroscopic assessment was made from the operation. Appendectomy and a histopathology examination were performed on all patients. Gross description was compared with histopathology results and then correlated with CRP, WBC, and NP. RESULTS The observational accuracy was 87,3%, as compared to histopathological accuracy which was 85.5% with a total of 173 patients that were operated on. The histopathology showed 25 (14.5%) patients had normal appendices, and 148 (85.5%) patients had acutely inflamed, gangrenous, or perforated appendicitis. 52% were male and 48% were female, with the age ranging from 5 to 59 with a median of 19.7. The gangrenous type was the most frequent (52.6%). The WBC was altered in 77.5% of the cases, NP in 72.3%, and C-reactive protein in 76.9% cases. In those with positive appendicitis, the CRP and WBC values were elevated in 126 patients (72.8%), whereas NP was higher than 75% in 117 patients (67.6%). Out of 106 patients with triple positive tests, 101 (95.2%) had appendicitis. The sensitivity, specificity, and positive predictive values of the 3 tests in combination were 95.3%, 72.2%, and 95.3%, respectively. CONCLUSION The raised value of the CRP was directly related to the severity of inflammation (p-value <0.05). CRP monitoring enhances the diagnostic accuracy of acute appendicitis. The diagnostic accuracy of CRP is not significantly greater than WBC and NP. A combination of these three tests significantly increases the accuracy. We found that elevated serum CRP levels support the surgeon's clinical diagnosis.
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Krajewski S, Brown J, Phang PT, Raval M, Brown CJ. Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis. Can J Surg 2011; 54:43-53. [PMID: 21251432 DOI: 10.1503/cjs.023509] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Clinical evaluation alone is still considered adequate by many clinicians who treat patients with appendicitis. The impact of computed tomography (CT) on clinical outcomes remains unclear, and there is no consensus regarding the appropriate use of CT in these patients. We sought to evaluate the impact of abdominal CT on the clinical outcomes of patients presenting with suspected appendicitis. METHODS We conducted a systematic review of the literature to identify studies that examined clinical outcomes related to the use of abdominal CT in the diagnosis of acute appendicitis. Inclusion criteria were studies of adult patients with suspected appendicitis that evaluated the impact of abdominal CT on negative appendectomy rates, perforation rates or time to surgery. Two independent investigators reviewed all titles and abstracts and extracted data from 28 full-text articles. Statistical analysis was conducted using Review Manager 5.0.10 software. RESULTS The negative appendectomy rate was 8.7% when using CT compared with 16.7% when using clinical evaluation alone (p < 0.001). There was also a significantly lower negative appendectomy rate during the CT era compared with the pre-CT era (10.0% v. 21.5%, p < 0.001). Time to surgery was evaluated in 10 of the 28 studies, 5 of which demonstrated a significant increase in the time to surgery with the use of CT. Appendiceal perforation rates were unchanged by the use of CT (23.4% in the CT group v. 16.7% in the clinical evaluation group, p = 0.15). Similarly, the perforation rate during the CT era was not significantly different than that during the pre-CT era (20.0% v. 19.6%, p = 0.74). CONCLUSION This meta-analysis supports the hypothesis that the use of preoperative abdominal CT is associated with lower negative appendectomy rates. The use of CT in the absence of an expedited imaging protocol may delay surgery, but this delay is not associated with increased appendiceal perforation rates. Routine CT in all patients presenting with suspected appendicitis could reduce the rate of unnecessary surgery without increasing morbidity.
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Affiliation(s)
- Susan Krajewski
- Department of Surgery, University of British Columbia, Vancouver, BC
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13
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van Randen A, Bipat S, Zwinderman AH, Ubbink DT, Stoker J, Boermeester MA. Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology 2008; 249:97-106. [PMID: 18682583 DOI: 10.1148/radiol.2483071652] [Citation(s) in RCA: 203] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE This study was a head-to-head comparison of graded compression ultrasonography (US) and computed tomography (CT) in helping diagnose acute appendicitis with an emphasis on diagnostic value at different disease prevalences, commonly occurring in various hospital settings. MATERIALS AND METHODS MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched from January 1966 to February 2006. Prospective trials were selected if they (a) compared graded compression US and CT in the same patient population; (b) included more than 10 patients, otherwise, the study was considered a case report; (c) evaluated mainly adults or adolescents; (d) used surgery and/or clinical follow-up as reference standard; and (e) reported data to calculate 2 x 2 contingency tables for graded compression US and CT. Estimates of sensitivity, specificity, and positive and negative likelihood ratios (LRs) for US and CT were calculated. Posttest probabilities after CT and US were calculated for various clinically relevant prevalences. RESULTS Six studies were included, evaluating 671 patients (mean age range, 26-38 years); prevalence of acute appendicitis was 50% (range, 13%-77%). Positive LR was 9.29 (95% confidence interval [CI]: 6.9, 12.6) for CT and 4.50 (95% CI: 3.0, 6.7; P = .011) for US, yielding posttest probabilities for positive tests of 90% and 82%, respectively. Negative LR was 0.10 (95% CI: 0.06, 0.17) for CT and 0.27 (95% CI: 0.17, 0.43) for US (P = .013), resulting in posttest probabilities of 9% and 21%, respectively. Posttest probabilities for positive tests were markedly decreased at lower prevalences. CONCLUSION In head-to-head comparison studies of diagnostic imaging, CT had a better test performance than did graded compression US in diagnosing appendicitis. Ignoring the relationship between prevalence (pretest probability) and diagnostic value may lead to an inaccurate estimation of diagnostic performance.
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Affiliation(s)
- Adrienne van Randen
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Suite G1-227, 1105 AZ Amsterdam, the Netherlands.
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Intraabdominal Infections. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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