Frequency and Risk Factors of Acute Appendicitis in Patients with Equivocal Appendicitis

Authors

  • Safwan Abdul Rahim Department of Surgery, St Lukes Hospital, Kilkenny, Ireland

DOI:

https://doi.org/10.70749/ijbr.v3i4.1155

Keywords:

Acute Appendicitis, CT Findings, Equivocal Appendix

Abstract

Objective: “To determine the frequency of acute appendicitis in patients with equivocal appendix; CT interpretation and to assess risk factors that favor acute appendicitis in patients with equivocal appendix. Study design: Cross sectional study. Study place and duration: General Surgery Department of Tertiary Care Hospital in Karachi for 6 months from 11th July 2023 to 31st December 2023. Patients and method: After meeting selection criteria 172 patients were enrolled. The patient’s data was filled using a performa, including details regarding age, gender, Neutrophil-to-lymphocyte ratio, and WBC count Using HIMS database by data collectors. The Alvarado score greater than 7 was followed with CT scan and Histopathology. All the collected data was entered and analyzed on SPSS version 20. Results: The mean age of the patients was 35.06±14.24 years, 89 (51.7%) patients were male and 83 (48.3%) were diabetics. Appendicitis was detected on CT in 80 (46.51%) patients. In patients with positive appendicitis on CT, the mean neutrophil count was 88.87±6.58, mean lymphocyte count was 14.8±3.07 and mean NLR was 6.27±1.22. In negative patients was 88.74±6.57 (p-value=0.260). In patients with positive appendicitis on CT the and in negative appendicitis on CT patients was 14.75±2.92. In negative patients mean neutrophil count was 6.22±1.17, mean lymphocyte count was 14861.07±3066.26 and mean NLR was 14751.52±2917.27. The difference in parameters was insignificant whether patients were positive or negative for acute appendicitis. Conclusion: This study concludes that the frequency of acute appendicitis in patients with equivocal appendicitis as determined by CT interpretation is 46.51% while factors include age, gender, BMI, diabetes, and raised NLR showed no association with appendicitis on CT scan.

Downloads

Download data is not yet available.

References

Cho CS, Buckingham JM, Pierce M, Hardman DT. Computed tomography in the diagnosis of equivocal appendicitis. Australian and New Zealand journal of surgery. 1999;69 (9):664-7. https://doi.org/10.1046/j.1440-1622.1999.01660.x

Babington EA. Ultrasound Imaging of Appendicitis. Appendicitis-Causes and Treatments: IntechOpen; 2023.

Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, et al. The global incidence of appendicitis: a systematic review of population-based studies. Annals of surgery. 2017;266 (2):237-41. https://doi.org/10.1097/sla.0000000000002188

Lastunen KS, Leppäniemi AK, Mentula PJ. DIAgnostic iMaging or Observation in early equivocal appeNDicitis (DIAMOND): open-label, randomized clinical trial. British Journal of Surgery. 2022;109 (7):588-94. https://doi.org/10.1093/bjs/znac120

Krisem M, Jenjitranant P, Thampongsa T, Wongwaisayawan S. Appendiceal wall thickness and Alvarado score are predictive of acute appendicitis in the patients with equivocal computed tomography findings. Scientific Reports. 2023;13 (1):998. https://doi.org/10.1038/s41598-023-27984-8

Moteki T, Horikoshi H. New CT criterion for acute appendicitis: maximum depth of intraluminal appendiceal fluid. American Journal of Roentgenology. 2007;188 (5):1313-9. https://doi.org/10.2214/ajr.06.1180

Daly CP, Cohan RH, Francis IR, Caoili EM, Ellis JH, Nan B. Incidence of acute appendicitis in patients with equivocal CT findings. American Journal of Roentgenology. 2005;184 (6):1813-20. https://doi.org/10.2214/ajr.184.6.01841813

Madhuripan N, Jawahar A, Jeffrey RB, Olcott EW. The borderline-size appendix: grayscale, color doppler, and spectral doppler findings that improve specificity for the sonographic diagnosis of acute appendicitis. Ultrasound Quarterly. 2020;36 (4):314-20. https://doi.org/10.1097/ruq.0000000000000536

Richards MK, Kotagal M, Goldin AB. Campaigns against ionizing radiation and changed practice patterns for imaging use in pediatric appendicitis. JAMA pediatrics. 2015;169 (8):720-1. https://doi.org/10.1001/jamapediatrics.2015.0912

Kadi M, Nasr A, Shabkah AA, Alnahari R, Alhawi A, Alyamani R, et al. Histopathological examination of cases with acute appendicitis, A retrospective study at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Annals of Medicine and Surgery. 2022;81:104401. https://doi.org/10.1016/j.amsu.2022.104401

Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis. The American Journal of Surgery. 2020;219 (1):154-63. https://doi.org/10.1016/j.amjsurg.2019.04.018

Wijetunga R, Tan BS, Rouse JC, Bigg-Wither GW, Doust BD. Diagnostic accuracy of focused appendiceal CT in clinically equivocal cases of acute appendicitis. Radiology. 2001;221 (3):747-53. https://doi.org/10.1148/radiol.2213001581

Raman SS, Lu DS, Kadell BM, Vodopich DJ, Sayre J, Cryer H. Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review. American Journal of Roentgenology. 2002;178 (6):1319-25. https://doi.org/10.2214/ajr.178.6.1781319

Kamel IR, Goldberg SN, Keogan MT, Rosen MP, Raptopoulos V. Right lower quadrant pain and suspected appendicitis: nonfocused appendiceal CT—review of 100 cases. Radiology. 2000;217 (1):159-63. https://doi.org/10.1148/radiology.217.1.r00oc34159

Malone Jr A, Wolf C, Malmed A, Melliere B. Diagnosis of acute appendicitis: value of unenhanced CT. AJR American journal of roentgenology. 1993;160 (4):763-6. https://doi.org/10.2214/ajr.160.4.8456661

Lane MJ, Liu DM, Huynh MD, Jeffrey Jr RB, Mindelzun RE, Katz DS. Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology. 1999;213 (2):341-6. https://doi.org/10.1148/radiology.213.2.r99nv44341

Rao PM, Rhea JT, Novelline RA. Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. Journal of computer assisted tomography. 1997;21 (5):686-92. https://doi.org/10.1097/00004728-199709000-00002

Rhea J, Rao PM, Novelline R, McCabe C. A focused appendiceal CT technique to reduce the cost of caring for patients with clinically suspected appendicitis. AJR American journal of roentgenology. 1997;169 (1):113-8. https://doi.org/10.2214/ajr.169.1.9207509

Funaki B, Grosskreutz S, Funaki C. Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital. AJR American journal of roentgenology. 1998;171 (4):997-1001. https://doi.org/10.2214/ajr.171.4.9762983

Arshad M, Aziz LA, Qasim M, Talpur K. Early appendicectomy in appendicular mass–a Liaquat University Hospital experience. J Ayub Med Coll Abbottabad. 2008;20 (1):70-2.

Sim JY, Kim HJ, Yeon JW, Suh BS, Kim KH, Ha YR, et al. Added value of ultrasound re-evaluation for patients with equivocal CT findings of acute appendicitis: a preliminary study. European radiology. 2013;23:1882-90. https://doi.org/10.1007/s00330-013-2769-2

Nanjundaiah N, Mohammed A, Shanbhag V, Ashfaque K, Priya S. A comparative study of RIPASA score and ALVARADO score in the diagnosis of acute appendicitis. Journal of clinical and diagnostic research: JCDR. 2014;8 (11):NC03. https://doi.org/10.7860/jcdr/2014/9055.5170

Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American journal of epidemiology. 1990;132 (5):910-25. https://doi.org/10.1093/oxfordjournals.aje.a115734

Ozkan A, Gokce AH, Gokce FS. The importance of laboratory tests and Body Mass Index in the diagnosis of acute appendicitis. Polish Journal of Surgery. 2020;92 (6):7-11. https://doi.org/10.5604/01.3001.0014.3579

Balthazar E, Megibow A, Siegel S, Birnbaum B. Appendicitis: prospective evaluation with high-resolution CT. Radiology. 1991;180 (1):21-4. https://doi.org/10.1148/radiology.180.1.2052696

Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C. Acute appendicitis: CT and US correlation in 100 patients. Radiology. 1994;190 (1):31-5. https://doi.org/10.1148/radiology.190.1.8259423

Weyant MJ, Eachempati SR, Maluccio MA, Rivadeneira DE, Grobmyer SR, Hydo LJ, et al. Interpretation of computed tomography does not correlate with laboratory or pathologic findings in surgically confirmed acute appendicitis. Surgery. 2000;128 (2):145-52. https://doi.org/10.1067/msy.2000.107422

Peck J, Peck A, Peck C, Peck J. The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis. The American Journal of Surgery. 2000;180 (2):133-6. https://doi.org/10.1016/s0002-9610(00)00435-9

Downloads

Published

2025-04-26

How to Cite

Frequency and Risk Factors of Acute Appendicitis in Patients with Equivocal Appendicitis. (2025). Indus Journal of Bioscience Research, 3(4), 585-589. https://doi.org/10.70749/ijbr.v3i4.1155