Which one in the diagnosis of acute appendicitis: Physical examination, laboratory or imaging? A retrospective analysis in the light of pathological results
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MD, Instructor of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
MD, Instructor of General Surgery, Kaçkar State Hospital, Pazar, Rize, Turkey
Online publish date: 2018-01-17
Publish date: 2018-01-17
Eur J Gen Med 2018;15(2):69–73
Acute appendicitis is the most frequently performed emergent operation. Although the clinical signs, symptoms and physical examination are the mainstay of diagnosis, imaging and biochemical tests also help. We analyzed the reliability of our operation decision and the contribution of biochemical tests and imaging to diagnosis in the light of pathological results.

Material and Methods:
The files of 361 patients (199male and 162 female) who underwent appendectomy were analyzed retrospectively in terms of age, sex, physical examination, blood tests, imaging and pathological results.

The mean age of the patients was found 31±13.5. Pathology revealed normal appendix in 20.1% of the cases. The patients with a leukocytosis or more were found an increased possibility of acute appendicitis. Physical examination was still the mainstay in diagnosis and ultrasound had a low sensitivity.

Physical examination is still mainstay in acute appendicitis diagnosis. Leukocytosis of 11x103/ml or more increases the possibility of acute appendicitis.

1. Arikanoglu Z, Taskesen F, Kapan M, Gümüş H, Tacyildiz IH. Diverticulitis of Cecum Mimicking Plastron Appendicitis: A Diagnostic and Therapeutic Dilemma. Eur J Gen Med 2013;10(4):246–249. https://doi.org/10.29333/ejgm/82228.
2. Xharra S, Gashi-Luci L, Xharra K, et al. Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis. World J Emerg Surg. 2012 Aug 6;7(1):27. https://doi.org/10.1186/1749-7922-7-27.
3. Shuaib A, Shuaib A, Fakhra Z, Marafi B, Alsharaf K, Behbehani A. Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis. World J Emerg Med. 2017;8(4):276-280. https://doi.org/10.5847/wjem.j.1920-8642.2017.04.005.
4. Ozan E, Ataç GK, Alişar K, Alhan A. Role of inflammatory markers in decreasing negative appendectomy rate: A study based on computed tomography findings. Ulus Travma Acil Cerrahi Derg. 2017 Nov;23(6):477-482. https://doi.org/10.5505/tjtes.2017.36605.
5. Ceresoli M, Zucchi A, Allievi N, et al. Acute appendicitis: Epidemiology, treatment and outcomes- analysis of 16544 consecutive cases. World J Gastrointest Surg. 2016 Oct 27;8(10):693–699. https://doi.org/10.4240/wjgs.v8.i10.693.
6. Graff L, Russell J, Seashore J, Tate J, et al. False-negative and false-positive errors in abdominal pain evaluation: failure to diagnose acute appendicitis and unnecessary surgery. Acad Emerg Med. 2000 Nov;7(11):1244-55. https://doi.org/10.1111/j.1553-2712.2000.tb00470.x.
7. Serres SK, Cameron DB, Glass CC, et al. Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children. JAMA Pediatr. 2017 Aug 1;171(8):740-746. https://doi.org/10.1001/jamapediatrics.2017.0885.
8. Van Rossem CC, Schreinemacher MH, Van Geloven AA, Bemelman WA. Antibiotic Duration After Laparoscopic Appendectomy for Acute Complicated Appendicitis. JAMA Surg. 2016 Apr;151(4):323-9. https://doi.org/10.1001/jamasurg.2015.4236.
9. Imran JB, Madni TD, Minshall CT, et al. Predictors of a histopathologic diagnosis of complicated appendicitis. J Surg Res. 2017 Jun 15;214:197-202. https://doi.org/10.1016/j.jss.2017.02.051.
10. Andersson RE. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg. 2007 Jan;31(1):86-92. https://doi.org/10.1007/s00268-006-0056-y.
11. Cameron DB, Williams R, Geng Y, et al. Time to appendectomy for acute appendicitis: A systematic review. J Pediatr Surg. 2017 Nov 20. pii: S0022-3468(17)30762-5.
12. Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med. 2014 Nov;15(7):859-71. https://doi.org/10.5811/westjem.2014.9.21568.
13. Gürleyik G, Gürleyik E. Age-related clinical features in older patients with acute appendicitis. Eur J Emerg Med. 2003 Sep;10(3):200-3. https://doi.org/10.1097/00063110-200309000-00008.
14. Khan MS, Chaudhry MBH, Shahzad N, Tariq M, Memon WA, Alvi AR. Risk of appendicitis in patients with incidentally discovered appendicoliths. J Surg Res. 2018 Jan;221:84-87. https://doi.org/10.1016/j.jss.2017.08.021.
15. Hwang ME. Sonography and Computed Tomography in Diagnosing Acute Appendicitis. Radiol Technol. 2018 Jan;89(3):224-237.
16. Reddy SB, Kelleher M, Bokhari SAJ, Davis KA, Schuster KM. A highly sensitive and specific combined clinical and sonographic score to diagnose appendicitis. J Trauma Acute Care Surg. 2017 Oct;83(4):643-649. https://doi.org/10.1097/TA.0000000000001551.
17. Giljaca V, Nadarevic T, Poropat G, Nadarevic VS, Stimac D. Diagnostic Accuracy of Abdominal Ultrasound for Diagnosis of Acute Appendicitis: Systematic Review and Meta-analysis. World J Surg. 2017 Mar;41(3):693-700. https://doi.org/10.1007/s00268-016-3792-7.
18. Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg. 2013 Feb;100(3):322-9. https://doi.org/10.1002/bjs.9008.
19. Tanrıkulu CŞ, Karamercan MA, Tanrıkulu Y, Öztürk M, Yüzbaşıoğlu Y, Coşkun F. The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis. Ulus Cerrahi Derg. 2015 Jun 1;32(2):115-21.
20. Hanson AL, Crosby RD, Basson MD. Patient Preferences for Surgery or Antibiotics for the Treatment of Acute Appendicitis. JAMA Surg. 2018 Jan 10. https://doi.org/10.1001/jamasurg.2017.5310.