Misdiagnosis of acute appendicitis is a common and crucial problem in general surgery, as the mortality and morbidity increase from 3 – 15 folds if appendix is perforated. Graded compression ultrasonography is one of the new diagnostic techniques that were introduced to improve the diagnostic accuracy and consequently the clinical outcome.
The aim of the current study is to assess the diagnostic accuracy of ultrasound in the diagnosis of suspected acute appendicitis.
One hundred-eighty patients admitted to the general surgical ward at Al Kindy Teaching Hospital from 1 June 2009 to 28 Feb. 2010. All patients were complaining of right iliac fossa pain and tenderness with a suspicion of acute appendicitis, a clinical assessment done for them by using modified Alvarado score (only patients with Alvarado score 5 and below were included). All patients were investigated by WBC count and general urine analysis. When the diagnosis of acute appendicitis was clinically equivocal, an abdominal ultrasound performed within 4 hours of admission. A dilated, Non- compressible appendix greater than 6 mm diameter, and edema and asymmetry of the appendicular wall were considered positive for the diagnosis of acute appendicitis. A normal appendix on histopathological examination with positive ultrasonographic findings was considered false positive result.
The findings according to histopathological examination shows that 160 cases were true positive cases,14 cases were found to be true negative , 1 cases was false positive and 5 cases were false negative cases.:
Ultrasonography yielded a sensitivity rate of 96% and specificity rate of 93%.
Ultrasound by graded compression technique provides highly accurate, sensitive and specific test for clinically equivocal acute appendicitis.