A Study on Clinical, Radiological and Operative profile of Acute Appendicitis

Dr. Brish Bhan Gupta; Dr.(Prof.) M.Arif Ansari

Volume : VIII, Issue : IV, April - 2019

A Study on Clinical, Radiological and Operative profile of Acute Appendicitis

Dr. Brish Bhan Gupta, Dr. Prof. M. Arif Ansari

Abstract :

Acute appendicitis is the most common surgically correctable cause of abdominal pain, the diagnosis of which remains difficult in many instances. Some of the signs and symptoms can be subtle to both the clinical and the patient and may not be present in all instances. Arriving at the correct diagnosis is essential; however, a delay may allow progression to perforation and significantly increased morbidity and mortality. Incorrectly diagnosing a patient with appendicitis although not catastrophic often subjects the patients to an unnecessary operation. The diagnosis of acute appendicitis is essentially clinical; however a decision to operate based on clinical suspicion alone can lead to removal of a normal appendix in 15–30% cases. Aims and objectives of the study was to To assess the association between clinical, radiological, operative and histopathological finding and thus evaluate clinical diagnostic accuracy and radiological diagnostic accuracy,To assess the effectiveness of radiological investigation in diagnosing acute appendicitis,To assess the importance and accuracy of clinical examination in acute appendicitis,In the present study, majority of cases were in the age group of 20–40 years, The ratio of male to female was 28:22. Abdominal pain was present in 90 % of cases. Fever was present in 92 % of cases while nausea and vomiting were present in 82 % of cases. Tenderness in right iliac fossa was present in 98% of cases. 98 % of patients showed Alvarado’s score of >7(s/o clinically positive). In majority of cases position of appendix was retrocaecal (62%), while pelvic position was present in 14 % of cases, and pre ileal in 10 % of cases. USG abdomen diagnosed 82 % cases of acute appendicitis and it showed negative results in 18% of cases which were clinically positive. Per operatively, in 96 % of cases appendix was diseased ( either inflammed or perforated), while only in 4 % of cases it was normal (non diseased). Histopathological examination revealed that in 96 % of cases, appendix was diseased, while in 4 % of cases it was completely normal. 96 % of cases were discharged from the hospital uneventfully. In almost all cases (98%) diagnosis is accurately made only on the basis of clinical examination, while in a significant number of cases (18 % ), radiological investigation used for diagnosis, failed to diagnose the positive cases. Acute appendicitis is a clinical diagnosis , although the radiological, biochemical and pathological evaluation in acute appendicitis is important. The history and clinical examination and Alvarado’s score is more significant to treat and manage the cases of acute appendicitis which has been proved from our study and the literature. The diagnostic accuracy of clinical features is far more better than radiological investigations in the diagnosis of acute appendicitis. Therefore it is concluded that acute appendicitis is more a clinical diagnosis rather than radiological and it is better to use radiological investigation only to confirm the diagnosis of acute appendicitis rather to diagnose it.