CLINICO-RADIOLOGICAL DIAGNOSIS OFAPPENDICITIS

Background : The symptom of right lower quadrant pain had puzzled clinicians for many centuries. Appendicitis needs to be considered in the differential diagnosis of nearly every patient presenting with acute abdomen, misdiagnosis of appendicitis is significantly higher in females. Early diagnosis remains the most important goal in patients, despite use of ultrasonography, CT scanning and diagnostic laparoscopy the rate of misdiagnosis of appendicitis and rate of negative appendicectomy is significantly high. Surgical treatment is a highly successful medical intervention In this study we have attempted to find a co-relation between the efficiency of clinical diagnosis with radiological diagnosis of appendicitis. Aim and Objectives: To determine the sensitivity, specificity and diagnostic accuracy of clinical scores, ultrasonography and CT of abdomen in a case of acute appendicitis. Materials and Method: 50 patients with acute onset lower abdominal pain and diagnosed as appendicitis were evaluated by the emergency surgical team.A detailed clinical evaluation was carried out as per criteria of the three clinical scores (Alvarado, Fenyo, Ohman).The inference from each of the scores was noted.The patients underwent ultrasonography(USG) and contrast CT of the abdomen and pelvis.The findings of both these investigations and intra operative findings were noted. The specimen was sent for histopathological examination which was considered as gold standard for the diagnosis of acute appendicitis. Result: In this study we found that Alvarado score had the highest sensitivity among females 92.31% and also the highest NPV 66.67%.Ohmann score had the overall highest sensitivity 100% and NPV Hence, it can be used as a simple, quick and effective screening score for detection of appendicitis in a large number of patients. The score is simple to use and can also be calculated by paramedical staff. USG of the abdomen is a useful screening tool however CT had a high specificity 88.89% and PPV 97.30% and diagnostic accuracy of 88%. Conclusion: Despite the advent of various investigation modalities, a surgeons clinical acumen should never be compromised. The clinical scores and investigations should always be used as an adjunct history taking and clinical examination. Appendicitis should always be considered as a differential diagnosis in every case of acute pain abdomen.