Accuracy of the Diagnosis in Patient with Acute Right Iliac Fossa Pain Undergoing Appendectomy: Ramathibodi Experience
Abstract
Introduction: Acute right iliac fossa pain is a common and difficult problem encountered by surgeons. The purpose of this study was to review the overall accuracy of the diagnosis of appendicitis in patients presenting with acute right iliac fossa pain, in which preoperative diagnosis of an acute appendicitis was made and the patients underwent appendectomy at Ramathibodi Hospital from January 2005 to September 2006.
Material and Methods: From January 2005 to September 2006, 206 patients with acute right iliac fossa pain and with clinical diagnosis of acute appendicitis were treated by appendectomy at Ramathibodi Hospital. 'Ten patients with incomplete data were excluded. One hundred and ninety-six patients with complete intraoperative records were reviewed. Patient demographic data, clinical presentation, preoperative investigations, types of operation, pathological reports and postoperative complications were reviewed. Alvarado scores were collected by chart review of history, physical examination and blood test.
Results: There were 91 males and 105 females. Accuracy of Alvarado score in the diagnosis of acute appendicitis was 93.4% in male and 80.9% in female. The sensitivity and specificity of ultrasonography in the diagnosis of acute appendicitis were 86% and 100%, respectively. CT scan was performed as an initial investigation in 7 patients. All patients with positive CT scan were found to have pathologically confirmed acute appendicitis. Twenty-one of the 91 male patients were found to have perforation compared with 17 of the 105 female patients (23% vs. 16%). Rates of pathologically confirmed acute appendicitis were 94.5 % in male group and 83.8% in female group with the overall rate of pathologically confirmed diagnosis at 88.8%. The rate of non- therapeutic appendectomy was 9.7%. Overall complications occurred in 14.6% and wound infection was the most common.
Conclusions: The diagnosis of acute appendicitis in patients with acute right iliac fossa pain who underwent appendectomy in our institution was comparable to previous studies with acceptable complication rate. We have slightly high rate of perforation in male patients but low rate of non-a cute appendicitis appendectomy. Our results suggested that clinical diagnosis remains valuable tools in the diagnosis of acute appendicitis.
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