Assessing the Efficacy of Ultrasound Imaging for Diagnosing Appendicitis in Male Patients: A Retrospective Study

TL;DR

This study evaluates how well ultrasound can diagnose appendicitis in men and finds it to be effective, though CT scans are better for patients with other health issues.

Contribution

The study provides specific ultrasound sensitivity and specificity rates for diagnosing appendicitis in male patients.

Findings

Ultrasound sensitivity for diagnosing appendicitis was 81% and specificity was 96%.

CT scans showed higher detection rates in patients with comorbidities compared to ultrasound.

Approximately 9.3% of patients underwent unnecessary appendectomy despite negative ultrasound results.

Abstract

Background: Inflammation in the vermiform region of the appendix is referred to as appendicitis. It can be diagnosed using clinical assessment and various imaging modalities. Among other imaging modalities, ultrasound (US) is an easily interpretable, cost-effective, and portable method. Unfortunately, the diagnosis of appendicitis presents a challenge due to its non-specific clinical presentation. In this respect, this study aimed to evaluate US sensitivity and specificity in diagnosing appendicitis in male patients.

Methods: This study was conducted at the Altnagelvin Hospital, Londonderry. We examined retrospective data on 237 male patients aged 14 years and above who presented with appendicitis and underwent US of the abdomen and/or appendix. We identified patients with confirmed appendicitis and/or secondary signs on imaging and those who underwent appendectomy with established inflammation at histology.

Results: In our study, the majority of patients were between the ages of 21 and 40 years (57.8%), with a smaller proportion of patients under 20 years (31.3%), between 41 and 60 years (7.0%), and over 60 years (3.9%). Interestingly, 9.3% of patients underwent appendectomy despite not having US-revealed appendicitis and the absence of secondary signs, while 24% of patients with no US-revealed appendicitis but with the presence of secondary signs underwent appendectomy, with 12% having pathological evidence of appendicitis. The sensitivity and specificity of ultrasound for diagnosing appendicitis were 81% and 96%, respectively. The proportion of US-revealed appendicitis was 20.5%, whereas other modalities (OM) showed positive results in 8.73% of cases. No association was observed between US-revealed appendicitis and comorbidities (p=0.99), whereas a significant association (p<0.01) was observed between appendicitis revealed by OM-based investigations (in particular, CT) and comorbidities.

Conclusion: US imaging could be a useful tool for diagnosing appendicitis, particularly in male patients; also, it can prevent unnecessary surgical intervention. Our findings suggest that US is an effective choice of imaging for initial diagnosis. However, in the case of associated pathologies, CT is the best choice for further evaluation.

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