The role of ultrasound in assessing acute right iliac fossa pain

Soran Sdeek Ahmed; Salwa A. Al-Najjar

doi:10.15218/zjms.2020.007

Authors

Soran Sdeek Ahmed Ministry of Health, Erbil, Iraq.
Salwa A. Al-Najjar Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.

DOI:

https://doi.org/10.15218/zjms.2020.007

Keywords:

Ultrasound, Abdominal pain, Right iliac fossa, Acute appendicitis

Abstract

Background and objective: Abdominal ultrasound can provide an effective, non-invasive, fast, inexpensive, and safe procedure with no risk of radiation to patients. Accordingly, this study aimed to assess the role of ultrasonography in differentiating causes of right iliac fossa pain among patients admitted to emergency hospitals in Erbil City.

Methods: In this cross-sectional study, 120 patients with acute abdominal pain and tenderness of right lower quadrant (iliac fossa) region, clinically suspected to have acute appendicitis admitted to the emergency hospitals in Erbil city were included in the study, from April 2011 to February 2012. The data was collected through a direct interview of patients, followed by a sonographic examination.

Results: The prevalence of true positive sonographic examination was 60.8%, with only 30% true negative findings. Around 69% of the cases had acute appendicitis, followed by ovarian cyst and right ureteric stone (11.1% and 7.4%, respectively). The sensitivity of sonographic examination in identifying appendicitis was 90.1%, the specificity was 92.3%. The positive predictive was 96%, while the negative predictive value was 81.8%. Sonographic characteristics of the positive patients with appendicitis showed that 58.0% of the patients had swollen appendix, and a diameter of 7.1- 8 mm was the most imaging finding. Also, appendicitis was significantly (P = 0.02) more common (58%) in males, and negative appendectomy was prevalent among females.

Conclusion: Appendicitis was the major cause of the right iliac fossa pain. Abdominal ultrasound was a reliable method in the diagnosis of the majority of patients with right iliac fossa pain and can decrease the rate of negative appendectomy.

Metrics

Metrics Loading ...

References

Wilson SR. Gastrointestinal sonography. Abdom Imaging 2002; 21:1–11.

Puylaert JB. Ultrasound of acute GI tract conditions. Eur Radiol 2001; 1:1867–77.

Sabatino A, Armellini E, Corazza GR. Doppler sonography in the diagnosis of bowel disease. Dig Dis 2004; 22:63–6.

Schmutz GR, Benko A, Fournier L, Peron JM, Morel E, Chiche L.. Small bowel obstruction: role and contribution of sonography. Eur Radiol 2007; 7:1054–8.

Lim JH, Ko YT, Lee DH, Lee HW, Lim JW. Determining the site and causes of colonic obstruction with sonography. AJR Am J Roentgenol 2001; 163:1113–7.

Attard AR, Corlett M J, Kinder N J, Leslie AP, Fraser IA. Safety of early pain relief for acute abdominal pain. Br Med J 2002; 305:554–60.

Engstrom L, Fenyo G. Appendicectomy: assessment of stump invagination, a prospective randomised trial. Br J Surg 2003; 72:971–2.

F Stuart, Morrisson I. The acute abdomen. Sutton D (editor). Textbook of radiology and imagining. 9th ed. London: Churchill Livingstone; 2003. P. 683–5.

Jeffrey RB, Jain KA, Nghiem HV. Sonographic diagnosis of acute appendicitis: interpretive pitfalls. Am J Roentgenol 2005; 162:55–9.

Kessler N, Cyteval C, Gallix B, Lesnik A, Blayac PM, Pujol J, et al. Appendicitis: Evaluation of sensitivity, specificity, and predictive values of US, Doppler US, and laboratory findings. Radiology 2004; 230:472–8.

Pickhardt PJ, Levy AD, Rohrmann CA JR, Kende AI. Primary neoplasms of the appendix: radiologic spectrum of disease with pathologic correlation. Radiographics 2003; 23:645–62.

van Breda Vriesman AC, Puylaert JB. Epiploic appendagitis and omental infarction: pitfalls and look-alikes. Abdom Imaging 2002; 27:20–8.

Jones P F. Suspected acute appendicitis: trends in management over the past 30 years. Br J Surg 2001; 88:1570–7.

Nitecki S, Assalia A, Schein M. Contemporary management of the appendiceal mass. Br J Surg 2009; 80:18–20.

Shelton T, McKinlay R, Schwartz RW. Acute appendicitis: current diagnosis and treatment. Curr Surg 2003; 60:502–5.

Assefa G, Meseret S, Nigussie Y. The role of ultrasound in diagnosing acute appendicitis. Ethiop Med J 2006; 44:67–74.

Benjamin IS, Patel A G. Managing acute appendicitis. Br Med J 2002; 325:505–6.

Beasley SW. Can we improve diagnosis of acute appendicitis? Br Med J 2000; 321:907–8.

Abu-Yousef MM. Ultrasonography of the right lower quadrant. Ultrasound Q 2001; 17:211–5.

Puylaert JB, Van der Zant FM, Rijke M: Sonography and the acute abdomen: practical considerations. AJR Am J Roentgenol 2006; 168:179–86.

Friday JH. Update on appendicitis: Diagnosis and pre-surgical management. Curr Opin Pediatr 2006; 18:234–8.

Rettenbacher T, Hollerweger A, Gritzman N, Gotwald T, Shwanmberger K, Ulmer H, et al. Appendicitis: Should diagnostic imaging be performed if the clinical presentation is highly suggestive of the disease? Gastroenterol 2002; 123:992–8.

Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing Epidemiology of Acute Appendicitis in the United States: Study Period 1993-2008. J Surg Res 2012; 175:185–90.

Sherazi AS, Sametzadeh M, Kamankesh R, Rahimi F. Accuracy of sonography in the diagnosis of acute appendicitis. Pak J Biol Sci 2010; 13:190–3.

Peixoto RO, Nunes TA, Gomes CA. Indices of diagnostic abdominal ultrasonography in acute appendicitis. Influence of gender and physical constitution, the time evolution of the disease and experience of the radiologist. Rev Col Bras Cir 2011; 38(2):105–11.

Khanal BR, Ansari MA, Pradhan S. Accuracy of ultrasonography in the diagnosis of acute appendicitis. Kathmandu Univ Med J 2008; 6:70–4.

Himeno S, Yasuda S, Oida Y, Mukoyama S, Nishi T, Mukai M, et al. Ultrasonography for the diagnosis of acute appendicitis. Tokai J Exp Clin Med 2003; 28:39–44.

Helo HR. The effectiveness of ultrasound imaging in the diagnosis of acute appendicitis. Basrah J Surg 2012; 18:89–96.

Amedy MM. The accuracy of ultrasound in the diagnosis of right iliac fossa pain in Erbil city. M.Sc. Thesis in radiology. College of Medicine; 2005.

Xifara S, Katergianakis V, Vlastarakos P, Skaltsas S, Loulakas I, Bramis I. The role of ultrasound in the diagnosis of acute appendicitis. Hellenic J Surg 2013; 85(1):35-41.

Rettenbacher T, Hollerweger A, Macheiner P, Rettenbacher L, Tomaselli F, Schneider B, et al. Outer diameter of the vermiform appendix as a sign of acute appendicitis: evaluation at US. Radiology 2001; 218(3):757–62.

Menten R, Lebecque P, Saint-Martin C, Clapuyt P. Outer diameter of the vermiform appendix: not a valid sonographic criterion for acute appendicitis in patients with cystic fibrosis.AJR Am J Roentgenol 2005; 184(6):1901–3.

Noudeh YJ, Sadigh N, Ahmadnia AY. Epidemiologic features, seasonal variations and false positive rate of acute appendicitis in Shahr- e-Rey, Tehran. Int J Surg 2007; 5:95–8.

Seetahal SA, Bolorunduro OB, Sookdeo TC, Oyetunji TA, Greene WR, Frederick W, et al. Negative appendectomy: a 10-year review of a nationally representative sample. Am J Surg 2011; 201(4):433–7.

Memon ZA, Irfan S, Fatima K, Iqbal MS, Sami W. Acute appendicitis: diagnostic accuracy of Alvarado scoring system. Sian J Surg 2013; 36(4):144–9.