Role of Ultrasonography in the Early Diagnosis of Acute Appendicitis

Abstract

Background: Acute appendicitis is among the most frequent surgical emergencies that are manifested by the acute abdominal pain and that need to be diagnosed as soon as possible to avoid the development of such complications as perforation and peritonitis. Clinical diagnosis is also difficult because of variable presentation, so it is necessary to use imaging techniques to detect the condition early and accurately, such as ultrasonography.

Aim: To evaluate the role of ultrasonography in the early diagnosis of acute appendicitis and to assess its diagnostic accuracy in correlation with clinical findings.

Methodology: The study was a prospective observational study carried out at the Department of Radio-Diagnosis, ICARE Institute of Medical Sciences and Research and Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal, India, a period of one year. One hundred and fifty patients having acute appendicitis clinically suspected were included. The information on the demographic features, the clinical presentation, and the ultrasonographic results were gathered and examined. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and general accuracy were considered to evaluate the diagnostic performance of ultrasonography.

Results: The majority of patients were in the 10–20 years age group (26.7%), followed by 31–40 years (23.3%). The most frequent symptom of presentation was right iliac fossa pain (100%), then nausea/vomiting (73.3%) and fever (63.3%). In 82% of cases, ultrasonography showed the non-compressibility of the appendix, and in 80% of patients it was seen that the appendiceal diameter exceeded 6 mm. Appendicolith (26.7%), periappendiceal fluid (20%), and the development of an abscess (10%), were also present. Ultrasonography had a sensitivity of 91.3, specificity of 88.2, PPV of 93.1, NPV of 85.0, and the overall diagnostic accuracy of 90%.

Conclusion: Ultrasonography is a very effective, noninvasive, and dependable diagnostic method that can be used to detect acute appendicitis at an early stage. Its sensitivity and accuracy are so high that it is a perfect initial imaging modality especially in resource-constrained facilities and can help in minimizing diagnostic delays and unwarranted surgery.

Keywords: Acute appendicitis, Ultrasonography, Diagnostic accuracy, Sensitivity, Specificity, Imaging.