SUSPECTED ACUTE APPENDICITIS: IMPACT OF ULTRASONOGRAPHY ON CLINICAL OUTCOME
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Purpose: To report our experience in using ultrasonography (US) with graded-compression technique in the evaluation of suspected acute appendicitis (AA). Patients and Methods: Between January 2003 and September 2004, 500 patients with clinical suspicion of AA (age range, 7-67 years; mean age, 35.5 years) were included in a prospective study. After clinical examination and laboratory analysis, the patients were assigned to undergo US examination. The results of sonographic diagnosis were correlated with surgical and clinical follow-up findings. Results: According to sonographic diagnosis, the patients were classified into two groups. Group A included 369 patients with sonographic diagnosis ofAA and group B comprised 131 patients with alternative diagnosis to AA. The final diagnosis of AA was achieved in 387 (77.4 %) out of the 500 patients with clinically suspected appendicitis. In group A, 352 (95.4 %) patients proved to have AA (true-positive based US results) while 17 (4.6 %) had false positive results. On the other hand US excluded the presence of AA in 96 (73.3 %) out of the 131 patients with altemative diagnosis to AA (true-negative based US results) and misdiagnosed 35 (26.7 %) patients proved to have AA (false-negative results). So the overall accuracy of US in the diagnosis of AA was 91 % (352/387). A total of 437 (87.4%) patients were surgically treated. The perforation rate was 23.2%. US accurately diagnosed perforation in 76.7 % and excluded the presence of perforation in 95.3 %. An appendicolith was identified with US in 28.4 % of patients with AA [71 % with - perforated AA 29 % of non-perforated AM. The negative appendectomy rate (NAR) was 4.3% (64.7 % men and 35.3% women). Conclusion: US using the graded-compression technique was able to accurately diagnose patients with suspected acute appendicitis and its complications as well as alternative diagnoses.