Negative Appendectomy: Is It Always Negative?

1998 ◽  
pp. 73-77 ◽  
Author(s):  
P. Puri ◽  
S.-G. Xiong ◽  
D.J. Reen
Keyword(s):  
Negative Appendectomy

Surgical Case

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Ali Hameed Al-Badri
Keyword(s):  
Diagnostic Delay ◽  
Small Population ◽  
Negative Appendectomy ◽  
Time Cost ◽  
Voluntary Cough ◽  
Suspected Appendicitis ◽  
Sharp Pain ◽  
Clinical Syndromes ◽  
Negative Appendectomy Rate ◽  
Classical Symptom

Appendicitis is a common and urgentsurgical illness with protean manifestations,generous overlap with other clinical syndromes,and significant morbidity,whichincreases with diagnostic delay. No single sign,symptom,or diagnostic test accurately confirms the diagnosis ofappendiceal inflammation in all cases. The surgeon's goals are to evaluate a relatively small population of patients referred for suspected appendicitis and to minimize the negative appendectomy rate without increasing the incidence of perforation. The emergency department clinician must evaluate the larger group of patients who present to the ED with abdominal pain of all etiologies with the goal of approaching 100% sensitivity for the diagnosis in a time-,cost-,and consultation-efficient manner.IN 1886Reginald fitz, pathologist 1st described the clinical condition of A.A.Fewyears laterCharles mcBurney describe the clinical finding ofA.A.55% of patients presented with classical symptom of A.A so complication occurbecauseof atypical presentation which due to variation in app. Position, age of patient & degree of inflammation.Migrating pain 80% sensitive and specific Vomiting 50% Nausea60 -90 %Anorexia 75 % Diarrhea18 % 32 % has similar attach 90 % RLQ tenderness Marklesign 74 %Dunphy's sign (sharp pain in the RLQ elicited by a voluntary cough) may be helpful in making the clinical diagnosis of localized peritonitis. Similarly,RLQ pain in response to percussion of a remote quadrant of the abdomen,or to firm percussion of the patient's heel,suggests peritoneal Inflammation

scholarly journals Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

EP.FRI.479 Clinical accuracy of u/sound combined with inflammatory markers in Acute Appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nadia Gulnaz ◽  
Sadia Tasleem ◽  
Farooq Abdullah
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Inflammatory Markers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Negative Appendectomy ◽  
Care Hospital ◽  
Clinical Accuracy ◽  
Negative Appendicectomy ◽  
Sensitivity Specificity

Abstract Traditionally acute appendicitis has been a clinical diagnosis based on patients' history and physical examination, but the accuracy of clinical diagnosis ranges from 70-95%. Pre-operative diagnosis of acute appendicitis still remains an enigmatic challenge, because no single test alone can reduce the rate of negative appendectomy. Hence some authors have recommended a combination of two or more investigations to increase accuracy and therefore the use of imaging is gaining support. The objective of the study was to determine the clinical accuracy of ultrasound, combined with inflammatory markers such as CRP, WBC, and neutrophilia keeping histopathology as the gold standard. Methods The study was conducted in a Tertiary care hospital in Peshawar from September 2014 to March 2015 on 250 patients who were clinically diagnosed with acute appendicitis. All these patients underwent u/sound scanning in addition to blood tests. Findings In this study, WBC had the highest sensitivity (77.68%) followed by neutrophil% (69.96%), CRP(67.10%), and U/Sound (62.96%) respectively. While U/Sound had the highest specificity (70.59%) followed by CRP and TLC (64.71% each) and neutrophil% (58.82%) respectively. When all the four tests were combined the sensitivity, specificity, (99.17% and 98.45%) increased significantly. When all four tests were negative, appendicitis could be safely ruled out. Conclusion Acute appendicitis is very unlikely and surgery can be safely deferred in these patients when all tests are negative thereby reducing the negative appendicectomy rates. 

Effect of Cross-sectional Imaging on Negative Appendectomy and Perforation Rates in Children

Radiology ◽  
2001 ◽  
Vol 220 (1) ◽  
pp. 103-107 ◽  
Author(s):  
Kimberly E. Applegate ◽  
Carlos J. Sivit ◽  
Ann E. Salvator ◽  
Valerie J. Borisa ◽  
David L. Dudgeon ◽  
...  
Keyword(s):  
Negative Appendectomy ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

scholarly journals Comparison of Clinical Features Between Patients with Positive and Negative Appendectomy

2020 ◽  
Author(s):  
Guner Cakmak ◽  
Baris Mantoglu ◽  
Emre Gonullu ◽  
Kayhan Ozdemir ◽  
Burak Kamburoglu
Keyword(s):  
Acute Appendicitis ◽  
Clinical Features ◽  
Total Bilirubin ◽  
Negative Appendectomy ◽  
C Reactive Protein ◽  
Future Studies ◽  
Female Patients ◽  
Reactive Protein ◽  
Male Patients ◽  
The Mean

Abstract Background: The objective of this study was to retrospectively compare clinical features and prognostic values between the patients who were referred to the general surgery clinic of our hospital with the presumed diagnosis of acute appendicitis and underwent positive or negative appendectomy.Methods: Patients were divided into two groups as positive (PA) (n:362) and negative appendectomy (NA) (n:284) and the data obtained were compared between these two groups.Laboratory investigations were performed in all patients, and white blood cell (WBC), mean platelet volume (MPV), neutrophils count (NEU), neutrophils (%) (NEU%), C-reactive protein (CRP) and total bilirubin (TBIL) values were studied.Results: The mean MPV value was found as 7.88 fl in PA groups and 8.09 fl in NA group, and the mean MPV value was not statistically significantly difference in PA group, compared to NA groups (p=0.012). Laboratory parameters were also compared between genders. Accordingly, the mean MPV value was statistically significantly higher in female patients compared to male patients in PA group (p = 0.04). The mean TBIL value was 0.97 mg/dl in PA group and 0.69 mg/dl in NA group, and the mean TBIL value was statistically significantly higher in PA group (p< 0.001). Finally, TBIL value was statistically significantly lower in female patients compared to male patients in NA and PA group (p < 0.05).Conclusions: According to the results of our study, MPV and T. BIL values differ in PA and NA groups depending on gender. Therefore, these values may not be used as specific biomarkers in predicting positive acute appendicitis. We believe that these results will contribute to the literature and will be guiding for future studies.

95 Evaluating The Rate, The Predictors And The Outcomes Of Patients With Negative Appendectomy(NAR)

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Noureldin ◽  
A Ayantunde ◽  
M Elkholy ◽  
H S Shah Heer Shah ◽  
A Hatim
Keyword(s):  
Serum Bilirubin ◽  
Lower Abdominal Pain ◽  
Inflammatory Cells ◽  
Female Gender ◽  
P Value ◽  
Negative Appendectomy ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Negative Appendicectomy ◽  
Definition Of

Abstract Introduction Appendectomy is associated with complications and negative appendicectomy. We evaluated the rate and predictors of NAR in a cohort. Method Patients' data who underwent emergency appendicectomies over a year was analysed. A definition of NA; absence of inflammatory cells in the appendix. The NAR was calculated using (NAR-SDC) and (NAR-STC). Leucocytosis was a total WBC &gt;11000/mm3, elevated CPR &gt;5 mg/L. Results 372 patients were included. Median durations of symptoms 2 days. The mean admission WBC, CRP and serum bilirubin levels were 12,600 (3000-38000)/mm3, 66.9 (1-323) mg/L and 12.7 (4-38) µmol/L respectively. Laparoscopic appendectomy was performed in 93.5% with a conversion rate of 4.6%.NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower WBC (p-value 0.014), CRP (p-value 0.0001) levels on admission. Female gender, duration of symptoms more than 3 days, lower WBC were found to be predictors of NAR. Conclusions NA is a problem in management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms more than 3 days, lower WBC were predictors of NA.

Imaging utilization affects negative appendectomy rates in appendicitis: An ACS-NSQIP study

2019 ◽  
Vol 217 (6) ◽  
pp. 1094-1098 ◽  
Author(s):  
Joshua Tseng ◽  
Tara Cohen ◽  
Nicolas Melo ◽  
Rodrigo F. Alban
Keyword(s):  
Negative Appendectomy ◽  
Acs Nsqip ◽  
Imaging Utilization

Abdominal Computed Tomography in the Evaluation of Acute and Perforated Appendicitis in the Community Setting

2007 ◽  
Vol 73 (10) ◽  
pp. 1002-1005 ◽  
Author(s):  
D.O. Vu Huynh ◽  
Fariborz Lalezarzadeh ◽  
Shokry Lawandy ◽  
David T. Wong ◽  
Victor C. Joe
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Predictive Value ◽  
Perforated Appendicitis ◽  
Community Setting ◽  
Diagnostic Value ◽  
Academic Community ◽  
Negative Appendectomy ◽  
Community Based ◽  
Abdominal Computed Tomography

Several studies report sensitivity and specificity of abdominal computed tomography scans (CT) for the evaluation of acute appendicitis as high as 98 per cent. Despite increased utilization of CT, the rate of negative appendectomy has remained constant at 10 to 20 per cent. The objective of this study was to assess the effectiveness of CT in the evaluation of acute and perforated appendicitis in an academic community-based setting. A retrospective review of 550 patient charts with International Classification of Diseases-9 (ICD-9) codes for acute and perforated appendicitis from January 2002 to October 2005 was performed. Sensitivity of CT was 87 per cent with a positive predictive value of 92 per cent. Specificity was 42 per cent with a negative predictive value of 29 per cent. Negative appendectomy rates were similar with or without CT (11% vs 13%, respectively). Our data suggests that CT used liberally in everyday practice in a community-based setting to evaluate acute appendicitis may not have as strong of a diagnostic value as those used in protocol-driven research studies. Further prospective studies are needed to formulate criteria to better delineate the role of CT in the evaluation of acute appendicitis.

scholarly journals Outcome of diagnosed cases of appendicitis and diagnostic accuracy of ultrasound of the appendix

2020 ◽  
Vol 13 (1) ◽  
pp. 56-59
Author(s):  
Bhoj Raj Sharma ◽  
Nawaraj Paudel ◽  
Santwana Parajuli ◽  
Sushma Singh ◽  
Madhu Maya Timilsina
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Surgical Outcome ◽  
Perforated Appendicitis ◽  
College Teaching ◽  
Free Fluid ◽  
Pelvic Cavity ◽  
Negative Appendectomy ◽  
Ultrasound Scan ◽  
Suspected Appendicitis

Background: Acute appendicitis is the most common condition requiring an emergency ultrasound scan as well as surgery. Several scoring systems for acute appendicitis has been suggested to improve diagnostic accuracy and decrease the negative appendectomy rate. In this study, we have evaluated the diagnostic performance of ultrasound on the diagnosis of acute appendicitis, other appendicular pathology, and correlate with surgical outcome. Material and methods: This retrospective study included 776 cases of ultrasound scan reports in which the appendix was visualized and not visualized or equivocal. Data were collected from October 2014 to April 2019 from different department and wards of Gandaki Medical College Teaching Hospital and Research Center (GMCTHRC). All the cases with diagnosed acute appendicitis, appendicular lump, and appendicular abscess were included and were followed for its surgical outcome. The surgical note or post-operative findings served as the reference standard for determining whether perforation was present or not. Result: There were 776 ultrasound scans for suspected appendicitis out of which 423 (54.5%) were diagnosed as appendicular pathology. Out of 423 diagnosed cases, 192 (45.4%) were males and 231 (54.6%) were females, with age ranging from 24 months to 87 years. Sonographic findings, in these positive subjects, suggested acute appendicitis, appendicular lump, abscess, and amount of free fluid in right iliac fossa (RIF) and pelvic cavity. Frank acute appendicitis was present in 378 (89.3%) cases, eight (1.9%) cases had an appendicular abscess, 23 (5.4%) had an appendicular lump and 14 (3.3%) had perforated appendicitis. Conclusion: We conclude that ultrasound is a good modality for visualization of appendicitis with other appendicular pathology. We could follow a structured report and identify pathology more specifically. Ultrasound is an easy and non-invasive test to investigate.  

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