RESUMEN
Objective: To evaluate the accuracy of surgeons' intraoperative diagnosis in open appendectomy and compare it with the histopathology examination results afterwards
Methods: This was a cross-sectional retrospective study accomplished in Namazee hospital affiliated with Shiraz University of Medical Sciences, in a one-year period from 2007 to 2008. Medical charts of all the patients who were admitted with impression of acute appendicitis and underwent open appendectomy in our center were included. Demographic information, intraoperative findings as in the operation note based on a method used by our surgeons, and histopathology examination of the removed appendix were recorded and reported
Results: A total of 342 patients were studied including 229 [67%] males and 113 [33%] females, with the mean age of 16.02 +/- 9.89 [range 3 to 76] years, with a large proportion from 10 to 15 years. Surgeons reported 97.4% of the patients to have acute appendicitis, 29.5%, 10.2% and 5.6% with severe, moderate and mild inflammation respectively, whereas 26.6% and 9.4% with suppurated and gangrenous appendicitis separately, 14.6% to have perforated appendicitis and only 1.5%hadperforated appendicitis with peritonitis. However, 79.5% of cases showed appendicitis in the histopathology review. The accuracy of surgeons' intraoperative diagnosis is 81.6%, 85.2% for men and 72.6% for women
Conclusion: The method used by our surgeon is not completely indicative in mild to severe inflamed appendix but it is almost always compatible with the pathology results in suppurated, gangrened, and perforated appendix. Therefore surgeons' gross observation of the inflamed appendix may not always be in concordance with the histopathology examination of the resected appendix
RESUMEN
Objectives: To evaluate the accuracy of sonography in diagnosing acute appendicitis in patients with Alvarado score 4-7
Methods: This is a retrospective cross-sectional study being performed in Namazee hospital affiliated with Shiraz University of Medical sciences during a one year period from 9/2007 to 9/2008. We evaluated all patients with Alvarado score 4-7 and divided them in two groups: those with Ultrasound study prior to surgery and those without any imaging modalities for diagnosis of AA. The demographic information, histopathology, physical examination, laboratory data, sonography report and histopathological reports of patients were gathered. Results: A total of 238 patients had Alvarado scores 4-7 including 160 males and 78 females. 110 patients did not have any imaging and 128 had undergone sonography before operation. Ultrasound had overall sensitivity of 75 %, specificity 69.2 %, PPV 88 %, NPV 46.1% and accuracy of 73.6 %. Negative appendectomy rate was 20.9 % and 23.4 % in those without sonography and inpatients with sonography respectively, with a higher rate in females
Conclusion: Ultrasound is more useful when the patient is female and the result of sonography is positive; however, it is not reliable when the result is negative and maybe other diagnostic modalities such as CT scan can> help us in better diagnosis of Acute Appendicitis
RESUMEN
Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis
Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz University of Medical Science during a 2-year period between 2008 and 2010. The medical records of all consecutive patients who underwent open appendectomy in our center due to acute appendicitis were included in the study. The elective and laparoscopic appendectomies were excluded. The demographic information, clinical findings, laboratory investigations and the histopathological examination of the appendix were recorded and reported
Results: A total of 337 patient including 137[36.4%] females, and 240[63.6%] males with the mean ageof 16.26 +/- 9.81 [range 3 to 76] years were stduied. Anorexia [64.7%]and fever [20.7%] were more prevalent symptoms. The mean duration between pain initiation and operation ranged from 0 to 14 days with mean 1.88 +/- 1.63 days. Right lower quadrant [RLQ], periumbilical, epigastria, left lower quadrant [LLQ], and Right upper quadrant [RUQ], pain were manifest in 78.8%, 41.6%, 12.2%, 3.2%, and 1.3% of patients, respectively Pathological evaluation of the appendix showed appendicitis in 70.4% of patients
Conclusion: The higher rate of negative appendectomy accounts for wasteful tapping of medical resources and causing further complication in patients. Therefore it is essential to conduct more accurate studies to detect the root cause of the disease. This would help improve the management of appendicitis which is an emergency condition with high incidence