Analysis of computed tomography and laboratory indices in patients operated for acute appendicitis

Öz

Purpose: Evaluation of the efficacy of complete blood count (CBC) parameters and computed tomography (CT) for reduction of negative appendectomy rates was aimed. Materials and methods: One hundred and fifty-three patients operated between December 2015-December 2017 with preliminary diagnosis of acute appendicitis are retrospectively evaluated for sociodemographic variables such as age, gender, preoperative laboratory findings, abdominal CT reports. Results: Median age of the patients operated for preliminary diagnosis of acute appendicitis was 31 (18-76), 33.3% were females and 66.7% were males. Negative appendectomy rate was 15% (23/153). The difference of white blood cell, neutrophil count, neutrophil lymphocyte ratio, plateletcrit, neutrophil percentage values between appendicitis and normal appendix groups according to pathological reports were statistically significant. Abdominal CT results for acute appendicitis with 95% confidence interval was as; sensitivity 97.0% (92.4-99.2), specificity 86.4% (65.1-97.1), positive predictive value (PPV) 97.7% (93.7-99.2), negative predictive value (NPV) 82.6% (64.1-92.7). Conclusion: Acute appendicitis is one of most encountered diseases by surgeons and is hard to diagnose. Cases should be evaluated by anemnesis, physical examination, laboratory findings and imaging as a whole. It is useful to use CT in the diagnosis of appendicitis especially in female patients with high negative appendectomy rates.

Anahtar Kelimeler

• acute apendicitis
• negative appendectomy rate
• computed tomography
• sensitivity
• specificity

Akut apandisit nedeni ile opere edilen hastalarda bilgisayarlı tomografi ve laboratuvar değerlerinin analizi

Öz

Amaç: Negatif apendektomi oranını azaltmada hemogram parametreleri ve bilgisayarlı tomografinin (BT) etkinliğinin değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Aralık 2015-Aralık 2017 tarihleri arasında apandisit ön tanısı ile ameliyat edilen 153 hasta yaş, cinsiyet gibi sosyodemografik özellikleri, operasyon öncesi laboratuar bulguları, karın BT sonuçları açısından retrospektif olarak incelenmiştir. Bulgular: Apandisit ön tanısı ile opere edilen olguların ortanca yaşı 31(18-76)’dir ve olguların %33,3’ü kadın, %66,7’si erkektir. Bu çalışmada negatif apendektomi oranı %15 (23/153) olarak saptanmıştır. Patoloji sonucu apandisit olan ve normal apendiks olan gruplar arasındaki beyaz küre, nötrofil sayısı, nötrofil lenfosit oranı, plateletkrit, nötrofil yüzdesi değerleri arasındaki farklar istatistiksel olarak anlamlıdır. Karın BT’nin apandisit için %95 güven aralığı ile sensitivitesi %97,0 (92,4-99,2), spesifisitesi %86,4 (65,1-97,1), pozitif prediktif değeri (PPV) %97,7 (93,7-99,2), negatif prediktif değeri (NPV) %82,6 (64,1-92,7)’dir. Sonuç: Akut apandisit cerrahlar tarafından en sık karşılaşılan, tanı konması en zor hastalıklardan biridir. Olgular hikâye, fizik muayene, laboratuar sonuçları ve görüntüleme ile bir bütün olarak ele alınmalıdır. Negatif apendektomi oranlarının yüksek olduğu özellikle kadın hastalarda apandisit tanısında BT kullanılması faydalıdır.

Anahtar Kelimeler

• Akut apandisit
• negatif apendektomi oranı
• bilgisayarlı tomografi
• sensitivite
• spesifisite

Kaynakça

1. 1. Addiss DG, Shaffer N, Fowler BS, Taxuee RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-25. https://doi.org/10.1093/oxfordjournals.aje.a115734
2. 2. Di Saverio S, Birindelli A, Kelly MD, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016;11(1):34. https://doi.org/10.1186/s13017-016-0090-5
3. 3. Yigit Y, Yilmaz S, Ozbek AE, Karakayali O, Cetin B, Halhalli HC. Can platelet indices reduce negative appendectomy rates? Cureus. 2019;11(3). https://doi.org/10.7759/cureus.4293
4. 4. Florence M, Flum DR, Jurkovich GJ, et al. Negative appendectomy and imaging accuracy in the Washington state surgical care and outcomes assessment program. Ann Surg. 2008;248(4):557-63. https://doi.org/10.1097/SLA.0b013e318187
5. 5. Karaca F, Afşar ÇU, Almali N, et al. The effect of pretreatment neutrophil/leucocyte ratio on survival in patients with locally advanced esophageal cancer receiving chemoradiotherapy. Acta Medica Mediterr. 2017;33(6):905-11. https://doi.org/10.19193/0393-6384_2017_6_144
6. 6. Gunes Tatar I, Yilmaz KB, Sahin A, Aydin H, Akinci M, Hekimoglu B. Evaluation of clinical Alvarado scoring system and CT criteria in the diagnosis of acute appendicitis. Radiol Res Pract. 2016;2016. https://doi.org/10.1155/2016/9739385
7. 7. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64. https://doi.org/10.1016/s0196-0644(86)80993-3
8. 8. Andersson M, Andersson RE. The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg. 2008;32(8):1843-9. https://doi.org/10.1007/s00268-008-9649-y

9. 9. Hallan S, Åsberg A. The accuracy of C-reactive protein in diagnosing acute appendicitis—a meta-analysis. Scand J Clin Lab Invest. 1997;57(5):373-80. https://doi.org/10.3109/00365519709084584
10. 10. Albiston E. The role of radiological imaging in the diagnosis of acute appendicitis. Can J Gastroenterol. 2002;16(7):451-63. https://doi.org/10.1155/2002/623213
11. 11. Jones RP, Jeffrey RB, Shah BR, Desser TS, Rosenberg J, Olcott EW. Journal Club: the Alvarado score as a method for reducing the number of CT studies when appendiceal ultrasound fails to visualize the appendix in adults. AJR Am J Roentgenol. 2015;204(3):519-26. https://doi.org/10.2214/AJR.14.12864
12. 12. Dingemann J, Ure B. Imaging and the use of scores for the diagnosis of appendicitis in children. Eur J Pediatr Surg. 2012;22(03):195-200. https://doi.org/10.1055/s-0032-1320017
13. 13. Nielsen JW, Boomer L, Kurtovic K, et al. Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. J Pediatr Surg. 2015;50(1):144-8. https://doi.org/ 10.1016/j.jpedsurg.2014.10.033
14. 14. Collaborative NSR. Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy. Br J Surg. 2013;100(9):1240-52. https://doi.org/10.1002/bjs.9201
15. 15. Anderson SW, Soto JA, Lucey BC, et al. Abdominal 64-MDCT for suspected appendicitis: the use of oral and IV contrast material versus IV contrast material only. AJR Am J Roentgenol. 2009;193(5):1282-8. https://doi.org/10.2214/AJR.09.2336
16. 16. Schuh S, Chan K, Langer JC, et al. Properties of serial ultrasound clinical diagnostic pathway in suspected appendicitis and related computed tomography use. Acad Emerg Med. 2015;22(4):406-14. https://doi.org/10.1111/acem.12631
17. 17. Hui TT, Major KM, Avital I, et al. Outcome of elderly patients with appendicitis: effect of computed tomography and laparoscopy. Arch Surg 2002;137:995-998. https://doi.org/10.1001/archsurg.137.9.995
18. 18. Nah EH, Kim S, Cho S, Cho HI. Complete blood count reference intervals and patterns of changes across pediatric, adult, and geriatric ages in Korea. Ann Lab Med. 2018;38:503-511. https://doi.org/10.3343/alm.2018.38.6.503
19. 19. Andersson RE. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg. 2007;31(1):86-92. https://doi.org/10.1007/s00268-006-0056-y