Acute Appendicitis: Diagnostic Algorithm Using Routine Ultrasonography and Optional Computed Tomography

Abstract

Objective: To access the algorithm in diagnosis of acute appendicitis, using routine
ultrasonography and optional computed tomography (CT).
Material and Methods: It was prospective study of 128 patients presenting in emergency
department with complaint of pain right lower quadrant of abdomen. After clinical evaluation and
lab investigations, ultrasonography abdomen was done for all patients. If provisional diagnosis
was made on these bases, treatment was started. If ultrasonography findings were negative or
inconclusive, CT was done with intravenous contrast. The final diagnosis was made by
ultrasonography/CT report, operative findings, histopathology report of the removed specimen
and outcome of the treatment.
Results: After completion of initial clinical workup and ultrasonography, we were able to make
provisional diagnosis in 90 patients. Ultrasonography showed inflamed appendix in 76 patients,
alternate diagnosis in 14 patients and in 38 patients report was normal or inconclusive. CT was
done in these 38 patients. CT scan showed inflamed appendix in 15 patients and alternative
diagnosis in 4 patients. In 19 patients CT report was normal. 91 patients were operated for open
appendectomy. In 85 patients, inflamed appendix was proved on histopathology and in 6 patients,
appendix was normal. Accuracy of clinical diagnosis alone was 81%, with Ultrasonography was
85%, with CT was 97% and accuracy of whole diagnostic pathway was 95%.
Conclusion: In suspected case of acute appendicitis, diagnosis algorithm using routine
ultrasonography and optional CT yields high diagnostic accuracy. Patients with normal
ultrasonography and CT findings can be safely observed.