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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. [ABSTRACT FROM AUTHOR]

Accurate diagnosis of acute appendicitis (AA) is still a problem and is not always easy, even for experienced surgeons. Studies have shown that 20 to 30% of the appendices removedwere normal. Therefore, various scoring systems have been developed to aid in the diagnosis of doubtful cases and reduce the number of unnecessary appendectomies. The aim of this study was to assess the diagnostic value of different scoring systems in acute appendicitis. Material and methods. The study involved 94 patients who underwent laparotomy due to suspected acute appendicitis. Medical examination at hospital admission was performed by a resident and a general surgery specialist. The probability of AA was evaluated using six different scoring systems: Alvarado, Fenyo, Eskelinen, Ohman, Tzankis, and RIPASA. The resident calculated the results in individual systems. The decision to perform the operation was taken by a specialist surgeon who did not know the results. Results. Normal appendix was removed in 26% of cases. Eskelinen, RIPASA and Alvarado systems showed highest sensitivity (99%, 88% and 85%, respectively). Tzankis and Fenyo systems showed highest specificity (62% and 50%, respectively). Conclusions. Our study has shown limited value of scoring systems for the diagnosis of acute appendicitis. The systems may improve diagnostic accuracy as they require obtaining a more detailed medical history, and making a more thorough and organized data analysis. However, the scoring systems should be treated only as an aid to diagnosis [ABSTRACT FROM AUTHOR]

Background Children with acute abdominal pain represent most of the admitted cases to the pediatric surgical department, one third of these cases are acute appendicitis. Early diagnosis of "no appendicitis" or "appendicitis" on the basis of pediatric appendicitis score could potentially save emergency department's time and resource use and could avoid time cost and risks for further evaluation. Objective Evaluation of Samuel scoring system in diagnosing children with acute appendicitis and their need for surgery. Methods One hundred and twelve patients aged between 5 to 15 years who presented with abdominal pain suggestive of acute appendicitis were studied. A complete data from patients were analyzed by using Samuel score. The clinical findings used by previously mentioned scoring system were analyzed to determine reliability of pediatric appendicitis score (PAS). The Final diagnosis was determined by histopathological report for patients' undergone appendicectomy. Results The mean (median, SD) score for children with acute appendicitis and non-acute appendicitis were 4.9 (5, 1.8) and 4.6 (5, 1.7) respectively. No variable (of the known signs and symptoms regarded as pathognomonic for acute appendicitis) shows a significant value in the diagnosis of acute appendicitis. A PAS of ≥ 4 had a sensitivity, specificity, Positive predictive value (PPV), and Negative predictive value (NPV) of 0.78, 0.27, 0.87, and 0.16 respectively. Conclusion The diagnosis of acute appendicitis and the need for surgery is still a matter of clinical judgment which can be built with practice, and although the PAS could provide useful diagnostic information in children with suspected acute appendicitis, it cannot be used as sole method for determining the need for surgery. [ABSTRACT FROM AUTHOR]

Acute appendicitis is a common occurrence in children. The current trend is to perform appendicectomy once acute appendicitis is diagnosed. The aim of this study was to evaluate the types of pathology seen in appendices removed for acute appendicitis and correlate them with clinical features. The clinical, operative and histological records of 302 children who had appendicectomy at the Jos University Teaching Hospital from 1995-2003 were retrospectively reviewed. There were 123 (40.7%) boys and 179 (59.3%) girls (m: f = 1: 1.5). Their ages ranged from 2-15 years (median: 12 years). The main symptoms and signs at presentation were right lower quadrant abdominal pain, anorexia, nausea, vomiting, right quadrant tenderness, guarding and rigidity. Clinical impressions included simple acute appendicitis in 260 and perforated appendicitis in 42 patients. Of the 302 children who had clinical diagnosis of acute appendicitis, only 144 (47.7%) were confirmed at histology. Lymphoid hyperplasia was the most common pathology seen in the appendix specimens. The clinical impressions of acute appendicitis made by the surgeon agreed with pathologists' report in 63.9% and disagreed in 36.1% of cases. Negative appendicectomy rate was 52.3%. Although appendicectomy is the most commonly performed emergency abdominal surgery in children, the procedure is still associated with a high negative appendicectomy rate. [ABSTRACT FROM AUTHOR]

The present study investigates the effect of delay in appendicectomy on the outcome of surgery and also examines the contribution of patient and physician related delay to the stage of appendicitis.During a 12-month period, 114 consecutive adult patients undergoing appendicectomy for acute appendicitis were monitored prospectively. Time of onset of symptoms, presentation to the hospital, surgery consultation, decision to operate and starting of surgery were all noted. The stage of the appendicitis was identified based on operative findings and pathology reports. Postoperative events were recorded. The stage of appendicitis and outcome were related to the prehospital and in-hospital delay of each patient.There were three (2.6%) normal, 62 (54.4%) early inflamed and 49 (43%) cases of advanced appendicitis. The total delay from onset of symptoms to performance of appendicectomy was 2.4 times longer in the advanced appendicitis group than in the early inflamed appendicitis group. There was no significant difference in the in-hospital delay between the two groups. Delay in the resumption of oral feed and total hospital stay were significantly higher in the advanced appendicitis group.The present prospective study concludes that morbidity caused by acute appendicitis correlates directly with delay in treatment. In the majority of cases the delay in treatment is predominantly caused by patient related factors. The negative appendicectomy rate can be reduced by close observation of cases with clinical uncertainty without increasing the morbidity. [ABSTRACT FROM AUTHOR]