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PubMed1999

Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis.

BACKGROUND: The Alvarado score assigns a numerical value to eight signs and symptoms associated with acute appendicitis. Practically speaking, the Alvarado score is equivalent to one's degree of clinical suspicion. Ultrasound is used in many institutions to aid in the diagnosis of acute appendicitis. The following study compares the accuracy of the two modalities and examines the value of using both modalities together. STUDY DESIGN: This study is a retrospective review of all patients who underwent appendectomy for presumed acute appendicitis at our institution in 1995. Seventy-five patients had a preoperative ultrasound and all 94 patients received an Alvarado score from a retrospective chart review. RESULTS: Ten (10.6%) patients had a normal appendix removed. Ultrasound alone resulted in a correct diagnosis 87% of the time. Using the Alvarado score alone, a correct diagnosis was made 88% of the time. If the ultrasound alone were used for diagnosis, seven acute appendices would have been missed (10% false negatives) and three unnecessary operations would have been performed (4.6% false positives). If the Alvarado score alone were used for diagnosis, four acute appendices would have been missed (5.9% false negatives) and five unnecessary operations would have been performed (7.2% false positives). There were 45 true positives and no false positive results when both modalities were positive for appendicitis. When the Alvarado score was negative or equivocal, the addition of ultrasound decreased the false negative rate by 75%. CONCLUSION: When comparing ultrasound to the Alvarado score for the diagnosis of acute appendicitis, neither one is significantly advantageous. However, the false positive rate is reduced to zero when both studies are positive and ultrasound improved diagnostic accuracy when the Alvarado score was negative or equivocal. There is no advantage of ultrasound over the Alvarado score for the diagnosis of acute appendicitis. Ultrasound is unnecessary when one's degree of clinical suspicion is high. However, the additional information provided by ultrasound does improve diagnostic accuracy in the case of a negative or equivocal Alvarado score. Acute appendicitis is the most common surgical abdominal emergency with a lifetime prevalence of approximately one in seven.

Acute Disease↗
PubMedDate not supplied

[Recurrent abdominal pain and "chronic appendicitis"].

BACKGROUND: Chronic appendicitis may be the cause of recurrent abdominal pain. This hypothesis is the subject of controversy. The aim is to clarify the possible existence of a chronic inflammation of the appendix by a clinical and histopathologic study. METHODS: The case history and the preoperative symptoms and serum findings of 269 patients with appendectomy have been studied. All the appendices have been histologically examined. Chronic appendicitis was diagnosed when at least two typical histological factors of chronic inflammation were present. The histological findings of the appendices have been correlated with preoperative clinical and serum findings of the patients. 14-46 months after the appendectomy, the patients have been examined. RESULTS: Histological examination revealed 187 cases (69.5%) with acute appendicitis, 44 cases (16.3%) with non disease of appendix and 38 cases (14.2%) with chronic appendicitis. Recurrent abdominal pain and normal leukocyte count were closely correlated (chi 2 = 18.3, p < 0.001; chi 2 = 21.3, p < 0.001 respectively) with diagnosis of chronic appendicitis. 81.8% of 33 patients with chronic appendicitis who underwent follow-up had relief of all the symptoms after appendectomy. CONCLUSION: Therefore, the study seems to confirm the existence of a clinico-pathological condition that can be defined as chronic appendicitis, resolvable with appendectomy.

Abdominal Pain↗
PubMed2000

The accuracy of C-reactive protein in the diagnosis of acute appendicitis compared with that of clinical diagnosis.

BACKGROUND: Acute appendicitis is one of the most common surgical emergencies. Its diagnosis is usually made depending on presenting history, clinical evaluation and laboratory tests. It has been estimated that the accuracy of the clinical diagnosis of acute appendicitis is lying between 76% and 92% (1). Negative appendectomies are one of the burdens facing not only the general surgeon but also the patient himself and the society as a whole, since appendectomy, as any other operation, results in socio-economic impacts in form of lost working days and declined productivity. OBJECTIVES: To determine the accuracy of c-reactive protein (CRP) in the diagnosis of acute appendicitis in comparison with the accuracy of clinical diagnosis. METHODS: This is a prospective study of all appendectomized patients during a one-year period in King Hussein Hospital in Amman/Jordan. RESULTS: A total of 98 patients were included in this study. The diagnosis of acute appendicitis was histopathologically confirmed in 89 patients (91%), while 9 normal appendixes (9%) were removed. The readings of CRP were ranging between 0 and 11.7 mg/l (mean 5.6 mg/l) in patients with normal appendixes, and between 6-93.4 mg/l (mean 36.2 mg/l) in patients with acute appendicitis. Normal CRP readings were found in 4 patients with acute appendicitis, and of the 9 cases with normal appendectomy, CRP level was elevated in only one patient, so the CRP levels were true (positively or negatively) in 93 patients and it was false positive in one patient (11%) and false negative in 4 patients (4%). On the other hand, the clinical diagnosis was correct in 89 cases (91%) and false in 9 cases (9%), the difference is statistically significant (p value = 0.009). CONCLUSIONS: We conclude that CRP is very helpful in the diagnosis of acute appendicitis, but it doesn't replace the clinical skills of general surgeons.

Acute Disease↗
PubMed2001

Do normal leucocyte count and C-reactive protein value exclude acute appendicitis in children?

UNLABELLED: The present study aimed to determine the role of leucocyte count and C-reactive protein (CRP) measurements in the diagnosis of acute appendicitis in children. In particular, children with acute appendicitis but normal leucocyte count and CRP level were sought. The present study protocol was identical to those used in earlier studies on adult patients with suspected acute appendicitis. The mean preoperative leucocyte count and CRP value in 100 consecutive children with an uninflamed appendix at appendicectomy (group A) and in 100 consecutive patients with acute appendicitis (group B) were calculated. The numbers of patients with (i) both values normal, (ii) only leucocyte count raised, (iii) only CRP level raised, and (iv) both values raised were calculated in both groups A and B. Leucocyte count effectively (p < 0.001) separated children with uninflamed appendix (mean +/- SEM 10.2 +/- 0.4 x 10(9) l(-1)) from those with acute appendicitis (15.0 +/- 0.4 x 10(9) l(-1)), but the CRP value was of no use in this respect (p = 0.866; 31 +/- 4 mg l(-1) and 30 +/- 4 mg l(-1)). The most conspicuous finding was that in children with acute appendicitis, both values were normal in 7 out of 100 patients. CONCLUSION: Contrary to adult patients, normal leucocyte count and CRP value do not effectively exclude acute appendicitis in children.

Acute Disease↗
PubMedDate not supplied

[Acute appendicitis at the National University Hospital in Bangui, Central African Republic: epidemiologic, clinical, paraclinical and therapeutic aspects].

We carried out a retrospective study to analyse clinical, paraclinical and therapeutic aspects of acute appendicitis cases as the National University Hospital (CNHU) at Bangui in the Central African Republic. We compared our findings with those for other African countries and for industrialized countries. From September 15 1990 to February 15 1992, 285 patients underwent laparotomy to treat acute appendicitis. We carried out a study of clinical, paraclinical and therapeutic aspects on 57 patients with complete case histories (20% of the patients undergoing surgery). The appendices of these patients were sent to the Laboratory of Pathological Anatomy of the Faculty of Medicine at Marseille, France, for analysis. The frequency of appendectomy among patients undergoing visceral surgery by laparotomy with no acute traumatic abdominal syndrome was 42.3%. The incidence of appendectomy for the city of Bangui in 1991 was 36.5 per 100,000 inhabitants. These cases of appendicitis were diagnosed essentially on clinical grounds. Leukocyte counts exceeded 10,000 per mm3 in 30% of the patients. Histological examination revealed the presence of parasites in 10 cases : Schistosoma mansoni eggs (seven cases) and Ascaris lumbricoides eggs (one case) in patients with acute appendicitis and one case each of Schistosoma mansoni eggs and Ascaris lumbricoides eggs at the time of diagnosis but normal histological results for the removed appendix. Most of the patients consulted late, a mean of four days after the onset of symptoms. The frequency of appendectomy on principle was 12.7% and parenteral antibiotic treatment was prescribed systematically follow- ing surgery. The mean duration of hospital stay after surgery was 7.6 days. No early postoperative complications were noted. However, two late postoperative complications resulting in the death of the patient were observed, giving a mortality rate of 3.5%. These complications were one case of peritonitis after appendectomy involving intestinal resection and one case of occlusive syndrome with septic shock. The frequency of acute appendicitis at the CNHU at Bangui was similar to that reported in another tropical African country (~ 1%). However, the incidence of appendectomies at Bangui is lower than generally reported for western countries (15 to 40%). Positive diagnosis was made on classic data obtained on clinical examination and on associated biological data, if available. Parasites were identified on histological examination in some cases of acute appendicitis, but it is unclear whether these parasites were actually responsible for the appendicitis. Efficient examinations for the exploration of acute nonspecific abdominal pain, such as the measurement of inflammation indicators, particularly serum activated protein C levels, graded-compression ultrasound scans and celioscopy, should be made available in the hospitals of African countries to increase the precision of diagnosis and to decrease the still too high frequency of appendectomies performed on principle. The postoperative mortality rate at the CNHU of Bangui is higher than the low rates (0.1 to 0.25%) reported for industrialized countries but is close to those reported for African countries. This high rate of mortality results partly from the lateness of consultations, because patients in tropical Africa often consult a traditional healer before resorting to modern medicine, and partly from misdiagnoses.

Acute Disease↗
PubMed2001

[Acute appendicitis after blunt abdominal trauma].

Acute appendicitis is the most common acute surgical condition of the abdomen. The concept of lumen obstruction as the cause has been widely accepted in the pathogenesis of acute appendicitis. In the literature, we have found a few case reports and a retrospective clinical study related to abdominal trauma as a possible factor in etiology of acute appendicitis. Whether blunt abdominal trauma can be the inciting event leading to acute appendicitis or only is a coincidence is not clear. We represent a case of perforated acute appendicitis after blunt abdominal trauma. Although a causative relationship between trauma and appendicitis cannot be proved in our case, we suggest that appendicitis should be considered in the patients with blunt abdominal trauma for not only medical but also its potential legal implications.

Abdominal Injuries↗
PubMed2002

Improving the diagnosis of acute appendicitis with atypical findings by Tc-99m HMPAO leukocyte scan.

AIM: Even with careful observation, the overall false-positive rate of laparotomy remains 10-15% when acute appendicitis was suspected. Therefore, the clinical efficacy of Tc-99m HMPAO labeled leukocyte (TC-WBC) scan for the diagnosis of acute appendicitis in patients presenting with atypical clinical findings is assessed. PATIENTS AND METHODS: Eighty patients presenting with acute abdominal pain and possible acute appendicitis but atypical findings were included in this study. After intravenous injection of TC-WBC, serial anterior abdominal/pelvic images at 30, 60, 120 and 240 min with 800 k counts were obtained with a gamma camera. Any abnormal localization of radioactivity in the right lower quadrant of the abdomen, equal to or greater than bone marrow activity, was considered as a positive scan. RESULTS: 36 out of 49 patients showing positive TC-WBC scans received appendectomy. They all proved to have positive pathological findings. Five positive TC-WBC were not related to acute appendicitis, because of other pathological lesions. Eight patients were not operated and clinical follow-up after one month revealed no acute abdominal condition. Three of 31 patients with negative TC-WBC scans received appendectomy. They also presented positive pathological findings. The remaining 28 patients did not receive operations and revealed no evidence of appendicitis after at least one month of follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values for TC-WBC scan to diagnose acute appendicitis were 92, 78, 86, 82, and 90%, respectively. CONCLUSION: TC-WBC scan provides a rapid and highly accurate method for the diagnosis of acute appendicitis in patients with equivocal clinical examination. It proved useful in reducing the false-positive rate of laparotomy and shortens the time necessary for clinical observation.

Adolescent↗
PubMed2002

The role of selective computed tomography in the diagnosis and management of suspected acute appendicitis.

The negative appendectomy rate in patients with clinically diagnosed acute appendicitis is 20 to 40 per cent. Recently CT has emerged as a powerful diagnostic tool in the evaluation of suspected appendicitis and its routine use has been advocated. The objective of this study was to evaluate the impact of selective use of abdominal CT on the negative appendectomy rate. Three hundred eight patients were enrolled in this prospective study. Abdominal CT was performed in patients with uncertain clinical signs of appendicitis. CT was not performed in patients with either a very high or a very low index of suspicion. The results were compared with a retrospective analysis of 85 consecutive patients operated by clinical diagnosis alone. One hundred twenty-seven patients had a final diagnosis of acute appendicitis. CT was performed in 198 patients (64%). The sensitivity, specificity, and accuracy of CT scans were 91, 92, and 91 per cent, respectively. Surgical management plans were altered in 54 patients after obtaining the CT results; unnecessary delay in surgical treatment or unnecessary operations were prevented in 28 and 26 patients, respectively. In addition CT detected unrelated pathologies in 23 patients. CT was not performed in patients with low index of suspicion and none were found to suffer from acute appendicitis. The negative appendectomy rate was 17 per cent (7% men and 24% women) in patients selected for surgery on the basis of very high clinical suspicion alone. Overall the negative appendectomy rate with the selective use of CT was 16 per cent, which is significantly lower than the rate achieved by diagnosing patients on clinical grounds alone (24%). CT is highly accurate in diagnosing or ruling out acute appendicitis and may substantially decrease the negative appendectomy rate as well as unnecessary delayed observation. We believe that CT should be performed routinely in women with suspected appendicitis and selectively in men.

Abdominal Pain↗
PubMedDate not supplied

Comparison between technetium-99m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan and abdominal sonography to detect appendicitis in female patients with an atypical clinical presentation.

BACKGROUND/AIMS: Acute appendicitis is a clinically challenging surgical disease which is particularly difficult to diagnosis in women. An atypical presentation is a major obstacle to quickly diagnose acute appendicitis. METHODOLOGY: Fifty female patients with acute abdomen pain who were suspected of having appendicitis, but who had atypical findings were included in this study. After an intravenous injection of technetium-99m hexamethylpropyleneamineoxide (Tc-99m HMPAO) labeled white blood cells, serial anterior abdomen-pelvis images at 30 min, 60 min, 120 min and 240 min were obtained using a gamma camera. Meanwhile, at the point of maximal tenderness, abdominal sonography was performed with a graded compression technique for both longitudinal and transverse images. RESULTS: Thirty-two patients received a laparotomy for surgical and pathological diagnoses. The remaining 18 patients did not receive operations and showed no evidence of appendicitis after at least a one-month follow-up period. Two patients had false-positive white blood cell scan findings and 2 patients had false-negative white blood cell scan findings. The overall sensitivity, specificity, and accuracy for white blood cell scans in diagnosing appendicitis was 93.3%, 90.0%, 92.0%, respectively. One patient had false-positive abdominal sonographic finding and 5 patients had false-negative abdominal sonographic findings. The overall sensitivity, specificity, and accuracy for abdominal sonography scans in diagnosing appendicitis were 83.3%, 95.0%, and 88.0%, respectively. CONCLUSIONS: The Tc-99m HMPAO white blood cell scan provides a more sensitive and accurate method for the diagnosis of appendicitis in female patients with equivocal clinical presentation when compared with abdominal sonography.

Abdomen↗
PubMed1992

Detection of acute appendicitis by technetium 99 HMPAO scanning.

The diagnosis of acute appendicitis can be difficult. Barium enemas, computed tomography (CT) scans, ultrasound examinations and Indium scans are used to aid in making the diagnosis with varying degrees of success. This blinded, prospective study reports the use of a Technetium 99-m Hexamethylpropyleneamineoxide (HMPAO) labelled white blood cell scan in 30 patients with suspected appendicitis. Autologous white blood counts from 25 cc of whole blood labelled with Tc-99 HMPAO were reinjected into patients. Abdominal imaging was performed at a half hour postinjection and repeated at 2 to 4 hours postinjection. A positive study showed an increased isotope uptake in the right lower quadrant. Nineteen patients had histologically proven appendicitis. Three of these patients were excluded because they were operated on before scan completion. Thirteen of the remaining 16 patients with appendicitis had positive studies (false negative rate = 19%). All patients without appendicitis had either negative scans or scans that detected other intra-abdominal diseases, such as diverticulitis, tubo-ovarian abscess, or small bowel infarction (false positive rate = 0%). Overall, this Tc-99 HMPAO study had a sensitivity of 81 per cent, a specificity of 100 per cent and an overall accuracy of 89 per cent. The 4-hour Tc-99 HMPAO WBC scan is a useful, noninvasive test for confirming the clinical diagnosis of acute appendicitis, but it may prove more valuable as a diagnostic study to rule out appendicitis in patients that have abdominal pain of unclear etiology.

Acute Disease↗
PubMedDate not supplied

Predictive inflammatory parameters in the diagnosis of acute appendicitis in children.

Acute appendicitis is the most common abdominal surgical emergency in children. In order to determine the related factors for early diagnosis of acute appendicitis in children, we analyzed retrospectively from January 2001 to December 2002 the hospital records of 260 consecutive patients under 18 years of age operated on because of suspected acute appendicitis. The patients group comprised 163 males (62.7%) and 97 females (37.3%) with a mean age of 11.1 +/- 4.3 years (range from 0 to 18 years old). The accurate diagnostic rate of acute appendicitis in children was 81.5 percent and negative appendicectomy rate was 18.5 percent. When combining leukocytosis, elevated neutrophil count and elevated C-reactive protein, the specificity and positive predictive value in diagnosing acute appendicitis were increased. According to the application of multivariate logistic regression analysis, the significantly related factors in acute appendicitis were elevated neutrophil count (Odds ratio = 3.79, 95% confidence interval = 1.732-8.293, p < 0.001) and elevated C-reactive protein concentration (Odds ratio = 2.81, 95% confidence interval = 1.231-6.390, p < 0.05). In conclusion, total neutrophil count and C-reactive protein may serve as predictive parameters for early diagnosis of acute appendicitis in children.

Acute Disease↗
PubMed2004

Accuracy in diagnosis of acute appendicitis by comparing serum C-reactive protein measurements, Alvarado score and clinical impression of surgeons.

OBJECTIVE: To compare the accuracy of a surgeon's clinical diagnosis of acute appendicitis with Alvarado's predictive model and C-reactive protein (CRP) measurements. METHOD: The records of 231 adult patients between 14-75 years admitted to the hospital with suspected appendicitis from August 1999 to November 2001 were studied prospectively. Serum CRP measurements (217 patients) and Alvarado scores (231 patients) were performed before operations but were not taken into account prior to the decision to perform a laparotomy to compare the surgeon's clinical diagnosis. RESULTS: Based on the surgeon's clinical diagnosis, 193 patients underwent surgery, and 38 patients were observed. Histopathologic findings found acute appendicitis, confirming the surgeon's clinical impression, in 178 patients (positive predictive value = 92%) and normal appendix in 15 patients. Of the observed patients, 8 subsequently underwent operation for appendicitis (negative predictive value = 79%). Compared with the surgeon's clinical diagnosis (sensitivity 96% and specificity 67%), diagnosis based on an Alvarado score of > or = 7 had a lower sensitivity (79%) and that based on CRP of > 10 mg/l a much lower sensitivity (62%) and lower specificity (56%). Overall accuracy of these three diagnostic modalities were 90 per cent, 72 per cent and 61 per cent, respectively. However, median serum CRP value increased from 5 mg/l (range 3-188 mg/l) in patients with normal appendix, to 14 mg/l (range 3-222 mg/l) in patients with non-perforated appendicitis and 65 mg/l (range 3-213 mg/l) in patients with perforated or gangrenous appendicitis. CONCLUSION: The clinical assessment in diagnosing appendicitis by an experienced surgeon remains reliable and superior to either Alvarado score or CRP measurement. Nevertheless, Alvarado score and serum CRP measurements may be of value to the inexperienced surgeon, and a high Alvarado score and serum CRP should not be ignored.

Acute Disease↗
PubMed2004

The value of 5-hydroxyindolacetic acid levels in spot urine in the diagnosis of acute appendicitis.

BACKGROUND: We investigated the value of 5-hydroxyindolacetic acid (5-HIAA) levels in spot urine in the diagnosis of acute appendicitis. METHODS: Forty-three patients (11 females, 32 males; mean age 26.3 years; range 16 to 73 years) who were admitted to the emergency room with acute abdominal pain and suspected acute appendicitis were evaluated by means of physical examination, leukocyte counts, urine analysis, measurements of 5-HIAA in spot urine, abdominal x-rays, and sonography. Of these, 25 patients underwent appendectomy after a clinical diagnosis of acute appendicitis. Spot urine analyses were made in all the patients within the first hour of admission with the use of spectrophotometric and colorimetric methods; 5-HIAA levels were read at 540 nm. RESULTS: At laparotomy, 22 patients (88%; 3 females, 19 males; mean age 26.18 years; range 15 to 38 years) were found to have acute appendicitis (11 phlegmonous, 11 gangrenous), whereas three patients (12%; 2 females, 1 male) had negative findings. No significant differences were found between patients with confirmed acute appendicitis, patients without appendectomy, and those with negative laparotomy with respect to the mean leukocyte counts and 5-HIAA levels (p>0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 5-HIAA for the diagnosis of acute appendicitis were calculated as 22%, 93%, 71%, 62%, and 63%, respectively. CONCLUSION: Measurement of 5-HIAA levels in spot urine is not helpful in the diagnosis of acute appendicitis.

Abdominal Pain↗
PubMedDate not supplied

Laparoscopy in complicated pediatric appendicitis.

BACKGROUND: Complicated appendicitis (gangrenous or perforated) has been associated with increased risk for postoperative complications, especially intraabdominal abscess. Caution has been advised when attempting laparoscopic appendectomy for complicated appendicitis in children. The objective of our study was to assess the incidence of intraabdominal abscess formation after laparoscopic appendectomy in pediatric patients presenting with complicated appendicitis. METHODS: This is a retrospective review of 52 pediatric patients presenting with acute appendicitis at a single teaching institution who underwent laparoscopic appendectomy by a single surgeon. All laparoscopic procedures were completed without conversion. Treatment complications and outcomes were recorded for all cases. RESULTS: Five of the 52 patients (10%) had complicated appendicitis. One of the 5 patients (20%) developed intraabdominal abscess postoperatively and underwent laparoscopic drainage during the same admission. No other complications were noted. None of these patients was readmitted for wound infections or intraabdominal abscesses. The single postoperative abscess occurred early during our initial experience with laparoscopic appendectomy. CONCLUSION: Laparoscopic appendectomy seems to be a safe alternative for the treatment of complicated appendicitis in children. Caution is recommended during the initial experience of surgeons with this procedure, because the complication rate seems to be higher during the learning curve. Close postoperative follow-up and a high index of suspicion for development of complications is recommended. As surgeons' experience accumulates, the safety of the procedure seems to increase. A prospective, randomized trial is recommended to establish the role of laparoscopy in complicated appendicitis in the pediatric population.

Abdominal Abscess↗
PubMed1992

[99mTc-anti-granulocyte antibodies (BW 250/183) in the detection of appendicitis].

Scintigraphy with 99mTc-labeled anti-granulocyte antibodies (AGAb) was performed in 50 patients with suspected appendicitis. Sequential and static imaging as well as SPECT of the pelvis and abdomen was performed 2 h p.i. In all patients the diagnosis was confirmed either histologically or by long-term follow-up. 13 patients had histologically proven acute appendicitis. In 11 patients the appendix scan had been positive and in 2 patients the scan had shown no significant tracer uptake in the right lower abdomen. The remaining 37 patients turned out not to have acute appendicitis. 29 out of these patients had negative and 3 had positive scan findings. In 5 patients the scan was equivocal. Out of these patients 2 had pathologic findings on the left side of the abdomen which turned out to be acute diverticulitis in one patient and acute peritonitis in the other. The remaining 3 patients with unclear scintigraphic findings had no acute appendicitis. Scintigraphy with AGAb is fast and easy to perform and thus superior to cell labeling methods for diagnosing acute appendicitis. Sensitivity for the diagnosis of acute appendicitis was 85% with a specificity of 91%. Chronic or scarred non-granulocytic appendicitis--in which there is often no definite indication for surgery--was negative in our study except for two cases.

Acute Disease↗
PubMedDate not supplied

Application of the MANTRELS scoring system in the diagnosis of acute appendicitis in children.

UNLABELLED: Evaluation of abdominal pain in children poses a major challenge for the pediatrician and pediatric surgeon alike. Acute appendicitis is diagnosed in 1%-8% of children who present with acute abdominal pain in pediatric department. However, initial misdiagnosis rate in childhood is still high, so how to make early and adequate diagnosis of acute appendicitis is still a challenge to pediatrician. OBJECTIVE: Application of the MANTRELS scoring system (Alvarado score) was used in the diagnosis of acute appendicitis in children. METHODS: We retrospectively collected a total of 111 cases under 14 years who were proven to have acute appendicitis by operative and pathologic reports and 111 cases who were excluded from having acute appendicitis as control subjects from January 2001 to July 2003. We applied the MANTRELS scores to evaluate these patients. RESULTS: Using statistical analysis, the following four parameters: migration pain, rebounding tenderness, right lower quadrant tenderness, shift WBC count and total MANTRELS scores higher than 6 were shown to have discriminatory values (P<0.01). CONCLUSION: Assessment of the cases in children with suspected acute appendicitis by the MANTRELS scoring system can be an adjuvant method to help us in the early diagnosis of acute appendicitis.

Acute Disease↗
PubMed2006

Suspected acute appendicitis in female patients. Trends in diagnosis in emergency department in a University Hospital in Western region of Saudi Arabia.

OBJECTIVE: To determine the negative appendectomy rate; utilization, accuracy of Alvarado scale, ultrasound (US), computed tomography (CT) in diagnosis of acute appendicitis. METHODS: Hospital records of 124 female patients admitted for suspicious of acute appendicitis from January 2003-January 2004 to the Emergency Department (ED) at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia were reviewed retrospectively. We reviewed the age of patients, clinical presentation, Alvarado scale, US, CT, histopathological diagnosis of appendicular specimen. RESULTS: A total of 124 female patients aged 6-64 years were presented to ED with right iliac fossa pain. Of the total, 103 patients have appendectomies (83.1%), 21 (16.9%) patients underwent conservative treatment. Prevalence of advanced appendicitis was 13.7% and negative appendectomy rate was 27.2%. Accuracy rate of appendicitis with Alvarado scale was 67.7%, US was 57.9%, CT was 66.7%. Postoperative complications were found in 2.4%. Positive correlation was found between advanced cases and Alvarado scale (r=0.338), and hospital stay duration (r=0.250, p<0.01). CONCLUSION: Clinical findings and experience remain of major importance in appendicitis-diagnosis. When appendicitis appears with atypical presentations, it remains a clinical challenge. In such cases, laboratory and imaging investigation may be useful in establishing a correct diagnosis. Alvarado scoring system is easy, simple and cheap complementary aid for supporting the diagnosis of acute appendicitis especially for junior surgeons.

Acute Disease↗
PubMed1991

The role of Yersinia enterocolitica in appendicitis in the southwestern United States.

Infection with Yersinia enterocolitica had been associated with acute appendicitis in approximately six per cent of patients in northern European countries. However, the incidence of Y. enterocolitica in patients with appendicitis in this country is uncertain. Therefore, this study was undertaken to ascertain whether Y. enterocolitica is a possible infectious agent in appendicitis in the southwestern United States. Fifty prospective patients (35 men and 15 women) with an average age of 22.3 years (range 3 to 62 years) underwent appendectomy for presumed appendicitis. Portions of each specimen were cultured for Y. enterocolitica with highly selective media (Cefsulodin-Irgasan-Novobiocin [CIN] agar). Pathologically, 44 of the patients had appendicitis and 6 patients had normal appendices. Four of the 44 patients (9.1%) with appendicitis were found to be culture positive for Y. enterocolitica, while it was recovered from none of the normal appendices. This indicates that Y. enterocolitica may represent the major pathogen in acute appendicitis in a small, but distinct, portion of indigent patients within Los Angeles County as it does elsewhere in the world.

Acute Disease↗