RESUMO
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
RESUMO
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