Computed Tomography Scan for Minimising the Rate of Negative Appendectomy in Patients Suffering from Acute Right Lower Abdominal Pain
Introduction: Diagnosis and management of right lower abdominal pain which is frequently due to appendicitis, is still a subject of continuous study. The correct diagnosis will decrease the frequency of negative surgery with a decline in days of hospital stay and leads to the direction of healt...
Main Authors: | , , |
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Format: | Article |
Language: | English |
Published: |
JCDR Research and Publications Pvt. Ltd.
2018-04-01
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Series: | International Journal of Anatomy Radiology and Surgery |
Subjects: | |
Online Access: | http://www.ijars.net/article_fulltext.asp?issn=0973-709x&year=2018&month=April&volume=7&issue=2&page=RO38-RO43&id=2388 |
Summary: | Introduction: Diagnosis and management of right lower
abdominal pain which is frequently due to appendicitis, is
still a subject of continuous study. The correct diagnosis
will decrease the frequency of negative surgery with a
decline in days of hospital stay and leads to the direction
of health funds towards the proper target.
Aim: To evaluate the efficiency of Computed Tomography
(CT) scan in diagnosing the patients presenting with acute
pain at the lower right abdominal quadrant and its chance
for diminishing the rate of negative appendectomy in these
patients.
Materials and Methods: This study included 238
consecutive patients suffering from acute pain in the right
lower abdominal quadrant. All patients underwent clinical,
laboratory, and radiological evaluation. The abdominal
Ultrasonography (USG), and then a CT done in all cases.
Laparoscopy was not available in our emergency operating
theatre, so diagnostic laparoscopy was not possible and
laparotomy was done for the 238 patients as they had
a suspicion of the need for surgical intervention. The
harvested specimens sent for histological examination. We
excluded from our study the patients who were generally
stable with mild or no abdominal manifestations, as well as
with the negative USG and/or CT, they kept for 48 hours
under observation and then discharged on symptomatic
treatment, contact number for communicating in cases of
recurrent symptoms, and follow-up in the outpatient clinic.
Data were collected and statistically analysed.
Results: Appendectomy performed in 238 cases, out of
them 105 were males and 133 were females. Considering
histopathological diagnosis as the gold standard,
preoperative CT showed a significantly higher test validity
characters in comparison to the abdominal USG and
clinical examination with a sensitivity of 94.3%, a specificity
of 91%. On the other hand, USG showed a sensitivity rate
of 77.4%, a specificity rate of 76%. Clinical examination
showed a sensitivity rate of 74.8%, a specificity rate of
69.6%.
Conclusion: The preoperative CT for patients suffering
acute pain in the lower right abdominal region; is highly
recommended in suspicious cases and it diminishes the
rate of unnecessary laparotomies when the diagnostic
laparoscopy is not possible as well as it improves the true
positive surgical rate. |
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ISSN: | 2277-8543 2455-6874 |