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PubMed2004

The nonvisualized appendix: incidence of acute appendicitis when secondary inflammatory changes are absent.

OBJECTIVE: The objective of our study was to assess the importance of nonvisualization of the appendix and its association with acute appendicitis on helical CT when secondary inflammatory changes are absent. MATERIALS AND METHODS: After we received institutional review board approval, CT scans of 366 consecutive patients obtained for lower abdominal or right lower quadrant pain and to rule out appendicitis were retrospectively reviewed. Images were reviewed by an experienced abdominal radiologist and compared with the formal interpretation. The amount of right lower quadrant and pericecal fat was quantified on a scale of 0 (none) to 2 (abundant). Patients with a nonvisualized appendix and other findings compatible with acute appendicitis-such as abscess formation, localized perforation, periappendiceal fat stranding, or appendicolith-were excluded. RESULTS: The appendix could not be visualized by both reviewers in 46 (13%) of 366 cases. CT findings indicated another cause for the patient's symptoms in 12 cases (26%), including gastrointestinal and genitourinary processes. An alternate diagnosis was subsequently reached in 11 additional patients (24%) with follow-up imaging or clinical evaluation. Only one patient (2%) with a nonvisualized appendix had acute appendicitis, proven by surgical pathology. In this patient, there was paucity of fat in the right lower quadrant. CONCLUSION: In the absence of a distinctly visualized appendix and secondary inflammatory changes, the incidence of acute appendicitis is low. Nonvisualization of the appendix even when a small amount of fat is present in the right lower quadrant may safely exclude acute appendicitis if no secondary CT findings are present.

Abdomen, Acute↗
PubMedDate not supplied

Appendicitis in pregnancy.

BACKGROUND: Our urban practice had two incidences of documented appendicitis in pregnancy in a 24-hour period with two unique outcomes that prompted an inquiry. Appendicitis in pregnancy is relatively rare, but it has significant morbidity and is a cause of maternal and infant mortality. Abdominal pain is the most common presenting symptom, and the consideration of multiple pathologic disorders should be entertained. Accurate diagnosis of appendicitis in pregnancy is the largest challenge since the signs and symptoms may vary depending on the trimester in which the patient presents. METHODS: We undertook a systematic review of English-language articles from 1975 to 2005 using the key words "appendicitis," and "pregnancy" using MEDLINE, CINAHL, and Cochrane Controlled Trials Register databases. RESULTS AND CONCLUSIONS: The accurate diagnosis of appendicitis during pregnancy requires a high level of suspicion and clinical skills, and not merely relying on the classic signs and diagnostic testing. Primary care providers play an important role in recognizing potential signs and symptoms of appendicitis in pregnancy to initiate prompt action and reduce negative maternal and fetal outcomes.

Adult↗
PubMed2004

Is laparoscopic appendectomy useful for the treatment of acute appendicitis in Korea? A meta-analysis.

We performed a meta-analysis using results in the Korean literatures to determine whether laparoscopic appendectomy (LA) or open appendectomy (OA) provide the better outcome in possible acute appendicitis patients. To perform the meta-analysis, an extensive literature search was conducted, giving priority to the Journal of the Korean Surgical Society, and domestic literature in its search database, published since January 1993, to ascertain the usefulness of LA in the treatment of acute appendicitis. The criteria used for the quality evaluation were as follows: 1) study subjects must have been evaluated clinically for suspected acute appendicitis, and 2) articles were included only if sufficient data (e.g. patient number, mean and standard deviation of patient outcome variables) were available regarding patient outcomes for LA or OA treated appendicitis. Of the 136 articles retrieved, 8 studies (1,258 patients) were selected for quantitative meta-analysis. Because insufficient data was available in some studies, operating time and hospitalization days were assessed for all 8 studies, but the time required to return to full functioning was assessed for only 3 studies. Overall effect size estimates were calculated using a random effect model for four patient outcomes (operating time, Q=38.6699, p < 0.001; length of stay, Q=19.3876, p < 0.001; postoperative hospital stay, Q=20.9164, p < 0.001; and return time to full functioning, Q=41.5061, p < 0.001). Because the overall effect size for operating time was -0.3218 (95% confidence interval [CI] -0.6108 to -0.0328), LA operating time was significantly greater than that of OA. In addition, a significant difference was found between the two modalities in terms of the length of hospital stay. Overall effect size in terms of the time required to return to full functioning was 1.9757 (95% CI 1.0066 to 2.9448), and LA reduced the time required by about 2 days versus OA. Considering the overall odds ratio (0.33) and 95% CI (0.20 to 0.55) the incidence of wound infection was significantly lower in LA than in OA. This review of the published evidence suggests that LA is more useful for treating acute appendicitis, especially when perforated appendicitis is suspected.

Acute Disease↗
PubMedDate not supplied

An audit of appendicitis and appendicectomy in Kumasi, Ghana.

BACKGROUND: Acute appendicitis is a leading cause of emergency admission into our hospital. A report on 638 surgical abdominal explorations following emergency admissions for suspected acute appendicitis is presented. The study was conducted at the Komfo Anokye Teaching Hospital between January 1998 and December 2004. METHOD: During the 7-year period, all consecutive adult patients admitted to our hospital emergency department with suspected appendicitis and who subsequently had an operation done provided the material for the study. Patients whose symptoms settled without operation were excluded. A special proforma was designed to record patient demographic details, clinical features, laboratory data, operative findings and outcome of treatment. RESULTS: Six hundred and thirty-eight patients were studied. These were 408 men and 230 women; a male to female ratio of 1.7:1. The mean age was 32.4 +/- 15.0 S.D years. All patients were admitted with abdominal pains that were initially located at the umbilicus in 38.0% and diffused in 31.8%. Vomiting 85.7%, fever 73.0% and anorexia 49.0% were the most frequent associated symptoms. The mean duration of illness was 74 hours. Right iliac fossa pain and tenderness were present in 612 patients (89.22 %). The total white cell count was significantly raised (p = 0.05). Six hundred and thirty-eight appendicectomies were performed. Thirty-nine percent (249/638) of the appendices were perforated at operation and 25.9% (56/216) of the removed appendices had no histological evidence of inflammation. The complication rate was 43.1% and wound infection (41.5%) was the most common. The average stay in hospital was 7 days. There were 12 deaths--a mortality rate of 1.9%--mostly elderly patients. CONCLUSION: The diagnosis of appendicitis in our environment is clinical and based mainly on the combination of abdominal pains, signs of peritoneal irritation, and a raised total white cell count with neutrophilia. This mode of presentation is similar to that seen in other communities. The treatment of appendicitis in our hospital is appendicectomy. The negative appendicectomy rate of 25.9% falls within the range reported in other studies. More than a third of the appendices were perforated. The considerable morbidity and appreciable mortality from acute appendicitis in our community are due mainly to the late presentation of our patients.

Acute Disease↗
PubMed2003

Unveiling appendicitis.

The most common reason for performing abdominal surgery is appendicitis, which affects up to 12% of the population (Lemone & Burke, 2000). Appendicitis is acute inflammation of the vermiform appendix that is typically manifested by localised pain in the right lower quadrant of the abdomen (Holmes, 2001; Lemone & Burke, 2000; McCance & Huether, 2002; Wagner, McKinney & Carpenter, 1996). Abdominal pain is a very common complaint. However, pain in the lower right quadrant cannot be used as the gold standard in a nursing assessment as an indication of appendicitis. Approximately one third of patients with appendicitis will have pain that is spread across the abdomen similar to gastritis (Mattice, 1999). Therefore a more in depth nursing assessment is required. This paper looks at accurately assessing the other signs and symptoms of appendicitis. These may include changes in vital signs, behaviour and body positioning and a history of anorexia, nausea and vomiting. Unveiling appendicitis requires the performance of an accurate and thorough abdominal pain assessment. This competent assessment will assist in preventing complications such as perforation and peritonitis and ensure a better patient outcome (Wagner, et al., 1996; Wright, 1997).

Acute Disease↗
PubMed1999

Perforated appendicitis is not a contraindication to laparoscopy.

Recent studies have reported an increased risk of intra-abdominal abscess formation following laparoscopic operation for perforated appendicitis. We undertook this study to compare laparoscopic versus open appendectomy in the treatment of perforated appendicitis. Records of all patients undergoing an appendectomy between January 1994 and June 1997 were reviewed, classifying appendicitis as acute, gangrenous, or perforated based on the intraoperative findings. Operative procedures were categorized as open, laparoscopic converted to open, or laparoscopic. The study group included 690 patients; four hundred fourteen (60%) were acute, 77 (11%) were gangrenous, and 199 (29%) were perforated. Although mean length of stay was shorter for all patients undergoing laparoscopic appendectomy, patients with perforated appendicitis had similar length of stay between treatment groups. Mean operative time for open appendectomy was significantly shorter than for converted or laparoscopic appendectomy regardless of diagnosis (P<0.01). Ten patients (1.4%) developed an intra-abdominal abscess: six after open appendectomy (1.7%), one after converted appendectomy (3.7%), and three after laparoscopic appendectomy (1%). There was no significant difference in rate of abscess formation in patients with perforated appendicitis undergoing open, converted, or laparoscopic appendectomy. We conclude that laparoscopic appendectomy for perforated appendicitis is not associated with an increased rate of intra-abdominal abscess formation.

Adolescent↗
PubMed1999

Clinical scoring system: a valuable tool for decision making in cases of acute appendicitis.

OBJECTIVE: Decision making in cases of acute appendicitis poses a clinical challenge specially in developing countries where advanced radiological investigations do not appear cost effective and so clinical parameters remain the mainstay of diagnosis. The aim of our study was to devise a scoring system from our local database and test its accuracy in the preoperative diagnosis of acute appendicitis. METHODS: Clinical data from 401 patients having undergone appendectomy were collected to identify predictive factors that distinguished those with appendicitis from those who had a negative appendectomy. Ten such factors were identified and using Bayesian probability a weight was assigned to each and the results summated to get an overall score. A cut-off point was identified to separate patients for surgery and those for observation. The scoring system was then retrospectively applied to a second population of 99 patients in order to compare suggested actions (derived from the scoring system) to those actually taken by surgeons. The sensitivity, specificity and accuracy for the level of decision was then calculated. RESULTS: Of the 99 patients, the method suggested immediate surgery for 65 patients, 63 of whom had acute appendicitis (3.1% diagnostic error rate). Of the 33 patients in whom the score suggested active observation, 18 had appendicitis. The accuracy of our scoring system was 82%. The method had a sensitivity of 78%, specificity 89% and a positive predictive value of 97%. The negative appendectomy rate determined by our study was 7% and the perforation rate 13%. CONCLUSION: Scoring system developed from a local database can work effectively in routine practice as an adjunct to surgical decision making in questionable cases of appendicitis.

Acute Disease↗
PubMed1999

[Is there a chronic appendicitis in childhood? Analysis of pediatric surgical patients from 1993-1997].

The right lower quadrant abdominal pain and the "chronic" appendicitis in childhood and adolescence are frequently connected with a lot of different diagnostical problems for the treating physician. Since the introduction of diagnostical laparoscopy and laparoscopical appendectomy in our hospital the rate of appendectomy has been increased to 35% in case of the histological diagnosis of "chronic" appendicitis. A special problem in childhood and adolescence is the request of the parents for clarification of chronic recurrent pain in their children and therefore the demand of laparoscopy and not seldom appendectomy. After appendectomy with the pathological-histological findings of "chronic" appendicitis children are in 83% without any abdominal pain. Therefore the question arises whether there exists a "chronic" appendicitis in childhood justifying surgery in these cases. Although the rate of complications and conversions (3.8%) in diagnostical laparoscopy and laparoscopical appendectomy is quite low the indication should only be made after careful examination considering differential diagnostical problems. In our hospital 56.5% of the children with the histological diagnosis of "chronic" appendicitis suffered retrospectively on other diseases, that had been caused the symptoms of appendicitis. Before operation the patients should be informed on the complications in detail.

Adolescent↗
PubMed2000

[Comments to dispute about catarrhal appendicitis].

One of the "blind-spots" in the problem of acute appendicitis is uncertainty in treatment policy for catarrhal appendicitis. Present-day pathophysiological approaches support necessity of different medical measures depending on morphological form of appendicitis. In diagnostic difficulties 186 patients underwent laparoscopy for appendicitis form specification. It is established that undestructive forms of vermiform appendix inflammation has characteristic clinico-endoscopic picture presented as primary (true), and secondary (false) appendicitis. Frequency of acute appendicitis when surgical treatment is required does not exceed 10% of total amount of appendectomies.

Appendectomy↗
PubMedDate not supplied

[Drainage of the abdominal cavity and complications in perforating appendicitis in children].

INTRODUCTION: Controversies regarding drainage and irrigation with antibiotics following perforated appendicitis still exist in literature. Some authors concluded that undrained patients treated with systemic antimicrobial therapy, adequate fluid resuscitation, emergency appendicectomy, peritoneal lavage and primary abdominal wall closure are less exposed to complications. On the other hand, Lund and Murphy and Schwartz and Tapper are still advocating transperitoneal drainage. In that context the aim of this study was to contribute to the current debate with its original results and conclusions. MATERIAL AND METHODS: A series of 56 children, who were operated on for perforated appendicitis during 1996 in Children's Hospital Podgorica and Pediatric Surgery Department of Hospital in Novi Sad, are reviewed. The average age of children in this series was 9.8 years (range, 2-14 years). All children were divided in two groups: patients included in the first group (n = 36) were treated with aggressive fluid resuscitation, preoperative triple antibiotic therapy, peritoneal lavage, avoidance of transperitoneal drains except those used for well-localized abscesses, primary wound closure and postoperative antibiotic therapy for seven to ten days. In the second group, children were managed in the same way, but silicon tube drainage after appendicectomy was included as well. Patients in both groups were given the same antibiotic therapy: intravenous metronidazole combined with gentamicin and ampicillin. RESULTS: Perforated appendicitis most frequently occurred in the age group between 8 and 15 years (77%), with highest incidence in male children (61%) of all children observed. Positive cultures were obtained from peritoneal swabs from 32 children (57%), of which all had pure growth of aerobes (Escherichia coli and Pseudomonas aerugionosa, mixed or pure). 36 children were managed by appendectomy followed by peritoneal lavage using a large amount of saline, and intravenous antibiotic therapy (undrained group), while the other 20 children were treated by appendectomy with silicon tube drainage and the same systemic antibiotic therapy (drained group). A minor complication rate was 43%; this includes 20 cases of wound infection and 4 cases of wound dehiscence. Major complications rate was 5%, which includes 3 cases of ileus. The mortality rate was zero. A comparison of the group that underwent drainage with undrained group showed a relative rate of wound infection to be 19% (undrained) vs. 65% (drained). According to the x2 test, this can be considered a significant difference, with Yates' correction. Wound dehiscence and ileus were more frequent in the drained group: 10% vs. 6% and 19% vs. 3%, respectively. DISCUSSION: The principal factors contributing to perforation of appendix are: age of children, delays of surgical intervention, family anamnesis, social group and late recognition of symptoms of appendicitis. Fast and adequate surgical intervention followed by adequate antibiotic therapy successfully resolve the cases of perforated appendicitis. The rate of serious post-appendectomy complications of 5-10% established by this study, can be considered as acceptable based on standards presented in the relevant literature. Regarding the reduction of wound infections following perforated appendicitis in children, aggressive therapy consisting of aminoglycosides combined with metronidazole have proven to be very efficient. Complications developed more frequently in the group of drained patients. Our results are in accordance with that achieved by authors cited in introduction: undrained patients are less prone to complications in comparison to drained patients. CONCLUSION: We achieved our lowest rate of serious complications following surgery for pediatric perforated appendix with the use of broad-spectrum antibiotic therapy, primary wound closure and without drainage. Regarding our results, we could propose the same treatment protocol to all in

Adolescent↗
PubMed2000

Laparoscopic appendectomy is feasible for the complicated appendicitis.

We reviewed the results of 339 consecutive appendectomies, including perforated appendicitis, to assess the advantages of the laparoscopic approach for acute appendicitis. Three hundred and eighty-eight patients underwent appendectomy at the Keimyung University Kyungju Dongsan Hospital between March 1994 and June 1996; 339 patients were treated using laparoscopic appendectomy (LA), and 49 patients who were treated with open appendectomy. Special emphasis was given to the results of LA in 27 patients with perforated appendicitis. The mean duration of the operating time for LA was 48.9 minutes. For six patients (1.8%), the procedure was converted to open surgery. Minor complications developed in eight patients (2.4%). There were no complications in the 27 patients with perforated appendicitis. Our experience with LA in perforated appendicitis is limited, but our results show that LA is a safe and acceptable procedure for all forms of acute appendicitis.

Acute Disease↗
PubMed2000

Ultrasonography and computed tomography in a clinical algorithm for the evaluation of suspected acute appendicitis in children.

AIM: To evaluate the roles and effectiveness of US and CT in a clinical algorithm for the evaluation of children with suspected appendicitis. METHODS: Patients with suspected appendicitis were prospectively evaluated with ultrasound (US), and in some cases with CT, after they were graded to have high, intermediate or low clinical likelihood for appendicitis. Imaging findings were made known to clinicians who then decided on a line of management. Patho-histological examination and clinical follow-up established the final diagnoses, which were correlated with the imaging findings. The effect of imaging on the management of patients was examined. RESULTS: Overall, the sensitivity of US was 92.9%, specificity 96.9%, accuracy 96.0%, positive predictive value 89.7% and negative predictive value 97.9%. Imaging did not affect the decision to operate in 13/14 (92.9%) patients in the high likelihood subgroup. Imaging guided the clinicians to the right management pathway in 26/30 (86.7%) patients in the intermediate group. 77/82 (93.9%) of US was truly negative in the low likelihood group. CT was performed in 12 patients because of unsatisfactory US scans or incompatibility between the US and the clinical findings. CT correctly diagnosed the presence or absence of appendicitis in all 12 patients. CONCLUSION: US and CT are accurate modalities in the diagnosis of acute appendicitis in children. US is most useful in patients with equivocal clinical findings. US should be the first modality used to evaluate children with suspected appendicitis. CT should be reserved for cases where US is sub-optimal or where the findings are inconsistent with the clinical findings.

Acute Disease↗
PubMedDate not supplied

Unenhanced spiral CT for evaluating acute appendicitis in daily routine. A prospective study.

BACKGROUND/AIMS: The purpose of this study was to define in a routine setting the role of spiral computed tomography in patients with suspected acute appendicitis and to determine the effect of computed tomography on the treatment of such patients. METHODOLOGY: Appendiceal computed tomography was performed in 120 consecutive patients with acute appendicitis in the differential diagnosis, whose clinical findings were insufficient to perform surgery or to discharge from the hospital. Each scan was obtained in a single breath hold from the lower abdomen to the upper pelvis using a 5-mm collimation and a pitch of 1.6. Computed tomography results were correlated with surgical and pathologic findings at appendectomy or clinical follow-up. RESULTS: Eighty-eight of the 93 patients with acute appendicitis were correctly diagnosed by computed tomography, 24 of the 27 patients without acute appendicitis were correctly diagnosed by computed tomography (95% sensitivity, 89% specificity). Computed tomography signs of acute appendicitis included fat stranding (100%), enlarged appendix (> 6 mm) (97%), adenopathy (63%), appendicoliths (43%), abscess (10%), and phlegmon (5%). CONCLUSIONS: The use of spiral computed tomography in patients with equivocal clinical presentation suspected of having acute appendicitis led to a significant improvement in the preoperative diagnosis and a lower negative appendectomy rate. Appendiceal computed tomography is an accurate technique even if performed in the daily routine of scanning.

Acute Disease↗
PubMedDate not supplied

[Validation of the Alvarado score in the diagnosis of acute appendicitis].

AIM: The aim of the study was to find out the values of the Alvarado score in diagnosis of acute appendicitis and its clinical applicability in our conditions. MATERIAL AND METHODS: A prospective study performed from November 15 to January 20, 2001 included 68 patients of whom 52 were operated. Patients were examined at the emergency department, and all received Alvarado score, whereas the surgeon made the decision if there were indications for surgery. In order to verify the diagnosis, we also used histopathological findings. RESULTS: From 52 operated patients, 43 (82.7%) had Alvarado score 7 or more, which confirms the diagnosis of acute appendicitis, and in all these patients the diagnosis was proved both intraoperatively and histopathologically. From 9 (17.2%) operated patients that had score less than 7, diagnosis of chronic appendicitis was proved in 3; in the rest 6 acute appendicitis was established. Alvarado score has high sensitivity of 87%, and average specificity of 60%. CONCLUSION: In diagnosis of acute appendicitis Alvarado score has a high diagnostic value (82.7%). Alvarado score is a noninvasive, safe diagnostic procedure, which is simple, fast, reliable and repeatable, it can be used in all conditions, without expensive and complicated supportive diagnostic methods. Alvarado score increases the diagnostic certainty of clinical examination in diagnosis of acute appendicitis.

Acute Disease↗
PubMed2002

Acute appendicitis in Yirgalem Hospital, southern Ethiopia.

The prevalence of appendicitis shows a marked variation between populations. The aim of this study is to determine the rate of prevalence of acute appendicitis in Yirgalem Hospital, in Southern Ethiopia. A retrospective analysis was undertaken on 200 cases of acute appendicitis surgically managed at Yirgalem Hospital from January 1997 to December 1999. During this period the disease accounted for 27.9% of the operations for acute abdominal emergencies and for 1.1% of total hospital admissions. There were 159 males and 41 females giving a male to female ratio of 3.9:1. The mean age was 25.6 +/- 10.9 years (range 4-90 years). The average duration of illness at presentation and hospital stay were 3.4 +/- 1.7 and 7.1 +/- 5.3 days, respectively. All the cases presented with abdominal pain and a shift of the periumbilical abdominal pain to the right lower quadrant was found in the majority. Right lower quadrant tenderness was the leading physical finding. The rate of simple and perforated appendicitis were 45.5% and 44%, respectively. Thirty-two per cent of the patients had postoperative wound infection. Out of the 200 patients operated upon for acute appendicitis 8 (4%) died. The study showed that the prevalence of acute appendicitis was low in Yirgalem Hospital and the results of the study were compared with those from elsewhere.

Adult↗
PubMedDate not supplied

[Laparoscopic approach versus laparotomy for suspected acute appendicitis].

Acute appendicitis is one of the most common surgical disease but, in spite of the progression diagnostic imaging, a definite diagnosis is frequently difficult and often is based in essentially clinical grounds. The Authors retrospectively analyze the results of conventional laparotomic appendectomy (CLA) and videolaparascopic appendectomy (VLA) as performed by two teams of their Department of Surgery. Between January 2000 and November 2001, 156 patients, age ranging from 3 to 67 yrs, underwent surgery because suspected acute appendicitis; 96 patients underwent VLA and 60 patients underwent CLA; a diagnosis of acute appendicitis was confirmed in 142 cases (91%). The patients who had a confirmed diagnosis of acute appendicitis were grouped according to clinical-pathologic criteria into follicular, gangrenous and complicated appendicitisi; operating time, complications and length of hospital stay were compared among the three groups. VLA resulted superior to CLA in terms of diagnostic performance: among the patients with suspected acute appendicitis, VLA allowed to establish a different diagnosis in 41% as compared to 13% with CLA. In two cases (2.08%) VLA was turned into CLA. There were non differences between VLA and CLA in terms of surgical operating time and hospital stay. A significantly higher incidence of surgical complications, such as wound infections and pelvic abscesses, was observed in the CLA group as compared to VLA. The Authors conclude that VLA allows a complete exploration of the abdomen, a better localization of the appendix and an easier diagnosis of unexpected conditions or pathologic processes associated with the clinical appendicitis; further, VLA is gravated by fewer complications.

Acute Disease↗
PubMedDate not supplied

The usefulness of technetium-99m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan to differentiate periappendiceal abscess from acute appendicitis--a preliminary report.

BACKGROUND/AIMS: The purpose of this study is to assess the usefulness of Tc-HMPAO (technetium-99m hexamethylpropyleneamineoxide) labeled white blood cells abdomen scan to differentiate acute appendicitis from periappendiceal abscess. METHODOLOGY: Forty-five patients with atypical symptoms and signs of appendicitis were included in this preliminary study. At 4 hours after an intravenous injection of Tc-HMPAO labeled white blood cells, static images over the anterior abdomen were obtained using a gamma camera. Two regions of interest were selected, one was over the lumbar spine and the other was over the appendiceal area. The mean count ratio of the appendiceal area over the mean pixel count of the lumbar spine was calculated. Sixteen patients were diagnosed with acute appendicitis and 19 patients with periappendiceal abscess by final operative findings. Meanwhile, the other 10 patients with acute abdomen but with no appendicitis served as controls. RESULTS: The mean count ratio of controls, acute appendicitis and periappendiceal abscess was 0.65 +/- 0.05, 0.82 +/- 0.07, and 1.25 +/- 0.11, respectively. If the mean count ratio > or = 1.00 was defined as the cutoff value to diagnose periappendiceal abscess, the specificity and the positive predictive value was 100%. CONCLUSIONS: We concluded that Tc-HMPAO white blood cells abdomen scan should be a potential tool to differentiate periappendiceal abscess from acute appendicitis.

Abdominal Abscess↗
PubMed2003

[The role of peritoneal aspiration cytology diagnosis of acute appendicitis].

BACKGROUND: The purpose of this study is to search the role of peritoneal aspiration cytology in acute appendicitis. METHODS: Peritoneal aspiration cytology was (PAC) conducted for fifty suspected acute appendicitis patients before their operations. PAC findings was compared with histopathologic results. RESULTS: Negative appendicectomy rate according to clinical diagnosis was 20%. PAC was positive in 32 and negative in 18 patients. 93.75% PAC (+) patients had acute appendicitis, 44.4% PAC (-) patients had normal appendices. The false positive rate was 6.2% and the false negative rate was 55.6%. The sensitivity, the specificity, the positive predictive value, the negative predictive value of PAC for the diagnosis of acute appendicitis were 75%, 80%, 93.8%, 44.4%, respectively and the accuracy was 76%. CONCLUSION: PAC positive results support the diagnosis of acute appendicitis strongly. However, PAC (-) results don't exclude the diagnosis of acute appendicitis.

Acute Disease↗