背景急性阑尾炎可以发生在任何年龄,但在极端年龄的人群中很少见;它在青少年和年轻人中更常见。传统的诊断是基于临床的。近年来,已采用成像技术来改善诊断并降低阑尾切除术的阴性率。该研究的目的是描述我们患者中急性阑尾炎的常见临床特征,突出医学影像的作用,并将所有这些与切除的阑尾的组织学报告进行比较。方法对2019年7月1日至2021年6月30日因疑似急性阑尾炎而接受阑尾切除术的所有患者进行为期24个月的回顾性分析。从手术室登记簿中检索阑尾切除术患者的病历编号。这些数字用于访问医院的电子病历数据库以获取患者的记录。这些记录被审查为生物数据,临床特征,实验室,医学影像发现,和组织学报告。结果在这家医院,进行了354例阑尾切除术。只有336个完整的数据集适合进一步审查。男性(N=257;76.5%)多于女性(N=79,23.5%),产生4:1的男女比例。还有更多的沙特公民(n=266,79.2%),主要年龄组为11-30岁。腹痛是主要症状(100%),在331例(98.7%)患者中位于右髂区。记录的其他症状是厌食症(n=247,73.5%),呕吐(n=190,56.5%),恶心(n=93,27.7%)。不典型的症状包括腹泻(n=27,8%)和便秘(n=12,3.6%)。急性阑尾炎,复杂性阑尾炎,174例(51.8%)无阑尾炎,124(36.9%),和38例(11.3%)。腹部CT扫描有较高的敏感性(98.6%vs70.5%),与超声检查相比,更高的诊断奇数比(2.5vs1.4)和更低的漏报(假阴性)率(1.4%vs29.5%).然而,CT扫描,从这项研究中,具有相当低的特异性(3.4%)和高的假阳性率(96.5%)。开腹(n=205;61%)和腹腔镜(n=131;39%)方法用于阑尾切除术。在我们的研究中,44名患者被诊断为基于临床理由决定手术;其中,42例(95.4%;n=44)有确认性阑尾炎的组织学报告。此外,38例阑尾切除术阴性;阑尾切除术阴性率为11.3%。这种高比率可能是由于在本研究中观察到的较低的特异性和高的假阳性率。术后并发症发生率为21.4%,这完全是由于手术部位感染,这在开放方法中更为常见(p=0.001)。结论疑似急性阑尾炎是阑尾切除术的唯一指征。计算机断层扫描是比超声检查更可靠的诊断工具。尽管急性阑尾炎主要是临床诊断,良好的临床敏锐度是管理患者的出色技能,我们观察到过度依赖医学影像学诊断.开放性阑尾切除术更常见,手术部位感染是手术的唯一并发症。对于影像辅助诊断,阑尾切除术的阴性率相对较高。
Background Acute appendicitis can occur at any age but is rare among people of extreme age; it is more common in teenagers and young adults. Traditionally diagnosis is made on clinical grounds. In recent times imaging techniques have been deployed to improve diagnosis and reduce negative appendicectomy rates. The aim of the study was to describe the common clinical features of acute appendicitis among our patients, highlight the role of medical imaging, and compare all these with the histological report of the excised appendix. Methods A 24-months retrospective review of all patients who underwent appendicectomy (July 1, 2019-June 30, 2021) for suspected acute appendicitis was performed. Medical records numbers of patients who had appendicectomies were retrieved from the operating room register. These numbers were used to access the hospital\'s electronic medical records database for the patients\' records. These records were reviewed for biodata, clinical features, laboratory, medical imaging findings, and histological reports. Result In this hospital, 354 appendicectomies were performed. Only 336 had complete data set suitable for further review. There were more males (N=257; 76.5%) than females (N=79, 23.5%), yielding a male to female ratio of 4:1. There were also more Saudi citizens (n=266, 79.2%), with the predominant age group being 11-30 years. Abdominal pain was the predominant symptom (100%) and was localized to the right iliac region in 331 (98.7%) of patients. Other symptoms recorded were anorexia (n=247, 73.5%), vomiting (n=190, 56.5%), and nausea (n=93, 27.7%). Atypical symptoms included diarrhoea (n=27, 8%) and constipation (n=12, 3.6%). Acute appendicitis, complicated appendicitis, and no appendicitis were the reported histological disposition in 174 (51.8%), 124 (36.9%), and 38 (11.3%) cases respectively. Abdominal CT scan had a higher sensitivity (98.6% vs 70.5%), higher diagnostic odd ratio (2.5 vs 1.4) and a lower miss (false negative) rate (1.4% vs 29.5%) compared to ultrasonography. However, the CT scan, from this study, has a rather low specificity (3.4%) and high false positive rates (96.5%). Open (n=205; 61%) and laparoscopic (n=131;39%) approaches were used for the appendicectomies. In our study, 44 patients were diagnosed with the decision to operate based on clinical grounds; and of this, 42 (95.4%; n=44) had confirmatory histology reports of appendicitis. Also, 38 patients had negative appendicectomy; giving a negative appendicectomy rate of 11.3%. This high rate may be due to the lower specificity and high false positive rate observed in this study. The post-operative complication rate was 21.4%, and this was solely due to surgical site infection, and this was more common with the open approach (p=0.001). Conclusion Suspected acute appendicitis was the sole indication for our appendicectomies. A computerized tomography scan was a more reliable diagnostic tool than ultrasonography. Despite the fact that acute appendicitis is majorly a clinical diagnosis, and good clinical acumen is an excellent skill in the management of patients, we observed an overreliance on medical imaging for diagnosis. Open appendicectomies were more common, and surgical site infection was the sole complication of surgery. There was a relatively high negative appendicectomy rate for an image-assisted diagnosis.