Combined Use of High Resolution Ultrasonography and Ripasa Score in Acute Appendicitis with the Aim to Reduce Negative Appendicectomy Rate
Journal Title: International Journal of Contemporary Medicine surgery and Radiology - Year 2018, Vol 3, Issue 1
Abstract
Introduction: Acute appendicitis has an unpredictable course which varies from complete resolution to perforation within a small time period. It is the most common cause of surgical acute abdomen presenting to emergency department where it is challenging for the surgeon to take a call for conservative or surgical management. Unnecessary surgery, failed conservative management leading to further complications, post surgical complications necessitate accurate diagnosis and prognosis which require combination of imaging and clinical measures. This study aims to compare specificity, sensitivity, positive and negative predictive value of RIPASA and HRUSG in diagnosis of appendicitis that requires surgical intervention Materials and methods: This is a prospective cross-sectional study with purposive sampling technique conducted among 150 patients suspected of acute appendicitis, referred for USG abdomen and underwent surgery for the same, in Father Muller Hospital. Clinical RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) score and HRUSG (high resolution ultrasonography) findings were noted and correlated with the histopathological findings. Results: Out of 150 patients, 62% were justified with surgery while 38% underwent unnecessary surgery that could have been prevented using criteria of RIPASA>11, Luminal diameter of >7.9 and degree of periappendiceal inflammation as per this study. Combination of HRUSG and RIPASA score has reduced the NAR (negative appendicectomy rate) from 39% on clinical alone and 7.4% on USG alone to 3.1%. Conclusion: The addition of HRUSG to clinical assessment of acute appendicitis increases the sensitivity and specificity, reduces the false positive rate (NAR), assists surgical decision making in doubtful cases to prevent complications and morbidity. HRUSG is also needed to rule out complications like mass formation/abscess/perforation where outcome of surgery is poor.
Authors and Affiliations
Soujanya Mynalli, Basavaraj N Biradar, Anston Vernon Braggs, Ram Shenoy Bast
Keywords
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