Evaluation of Noncontract computed tomography in diagnosing acute appendicitis
Abstract
Introduction: Appendicitis is a common disease, having a lifetime incidence of 7%. Surgeons have traditionally accepted negative appendectomy rate up to 20%. It is because of clinical myriad. Objectives of study were to determine the role of Noncontract Computed Tomography (NCCT) imaging in the detection of suspicious case of appendicitis. To estimate negative appendectomy rate (NAR) in preoperative evaluation of computed tomography (CT). Evaluate significance of Clinical, radiological and intraoperative parameters for diagnosing appendicitis.
Material and Method: This is evaluation of diagnostic test of 450 patients coming to Emergency Department with suspicion of acute Appendicitis have undergone NCCT. The study will be carried out in the Department of surgery Dr Shankarrao Chavan Government Medical College Nanded over a period of 24 months.
Result: An appendectomy was performed in 367 patients. All 367 patients underwent surgery their clinical and radiological correlation and intra-operative finding noted and surgical specimen sent for histopathological correlation. Clinically right iliac fossa pain, vomitting, temperature, RIF Tenderness, were found to be more consistent with acute appendicitis with significant p values. On establishing role of NCCT abdominal scan in diagnosing acute appendicitis significant parameters are Enlarged Appendix, Periappendicial fat stranding, Focal cecal apical thickening, Intra luminal Air these parameter are significant with p values. Omentum in right iliac fossa, Inflammed appendix, Periappendicular free fluid/pus is more consistent intra-operatively during appendectomy with significant p values 0.028.0.045, 0.026 respectively. Negative appendectomy rate in our study is 3.81%.
Conclusion: There was a significant reduction in the Negative Appendectomy Rate in patients undergoing NCCT for diagnosis. Uses of specific clinical radiological and intra-operative parameters become significant in diagnosing appendicitis. NAR might have medico legal importance to debate for difficult in diagnosing appendicitis preoperatively.
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References
2. Bongard F, Landers DV, Lewis F. Differential diagnosis of appendicitis and pelvic inflammatory disease. Am J Surg 1985;150:90 -96. [PubMed]
3. Eldar S, Nash E, Sabo E, Matter I, Kunin J, Mogilner JG, Abrahamson J. Delay of surgery in acute appendicitis. Am J Surg. 1997 Mar;173(3):194-8. [PubMed]
4. Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C. CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol. 2005 Aug;185(2):406-17.
5. Weston AR, Jackson TJ, Blamey S. Diagnosis of appendicitis in adults by ultrasonography or computed tomography: a systematic review and meta-analysis. Int J Technol Assess Health Care. 2005 Summer;21(3):368-79.
6. Ashraf K, Ashraf O, Bari V, et al. Role of focused appendiceal computed tomography in clinically equivocal acute appendicitis.J Pak Med Assoc. 2006;56:200-203.
7. Ege G, Akman H, Sahin A, et al. Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis.Br J Radiol. 2002;75:721-725. [PubMed]
8. in’t Hof KH, van Lankeren W, Krestin GP, et al. Surgical validation of unenhanced helical computed tomography in acute appendicitis. Br J Surg. 2004;91:1641-1645.
9. Keyzer C, Zalcman M, De Maertelaer V, Coppens E, Bali MA, Gevenois PA, Van Gansbeke D. Comparison of US and unenhanced multi-detector row CT in patients suspected of having acute appendicitis. Radiology. 2005 Aug;236(2):527-34.
10. Stacher R, Portugaller H, Preidler KW, et al. Acute appendicitis in unenhanced spiral CT: diagnostic luxury or benefit [in German]? Rofo. 1999;171:26-31. [PubMed]
11. T amburrini S, Brunetti A, Brown M, et al. Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings. Eur Radiol.2007;17:2055-2061. [PubMed]
12. Lane MJ, Katz DS, Ross BA, et al. Unenhanced helical CT for suspected acute appendicitis. AJR Am J Roentgenol. 1997;168: 405-409. [PubMed]
13. 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 Oct;249(1):97-106. doi: 10.1148/radiol.2483071652. Epub 2008 Aug 5. [PubMed]
14. Terasawa T, Blackmore C, Bent S, et al. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004; 141:537-546. [PubMed]
15. Weston AR, Jackson TJ, Blamey S. Diagnosis of appendicitis in adults by ultrasonography or computed tomography: a systematic review and meta-analysis. Int J Technol Assessm Health Care. 2005;21:368-379.
16. 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 Oct;249(1):97-106. doi: 10.1148/radiol.2483071652. Epub 2008 Aug 5. [PubMed]
17. Peck J, Peck A, Peck C, et al. The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis. Am J Surg. 2000;180:133-136.
18. Togawa A, Kimura F, Chiku T, et al. Simple way to improve accuracy in diagnosis of quadrant inflammatory disease: how to avoid adverse laparotomy by using plain CT. Hepatogastroenterology. 2005;52: 135-138.
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