Öz
Öz
Amaç
Cerrahi müdahale gerektiren akut abdomen sebepleri arasında akut apandisit önemli bir konuma sahiptir. Tanı sürecinin uzaması ile perforasyon, batın içi apse ve sepsis gibi komplikasyonlar gelişebilmekte, morbidite ve mortalite oranları artmakta, hastanede kalış süresi uzamakta, maliyetler yükselmektedir. Günümüz koşullarında kolaylıkla tedavi edilebilmesi, erken ve doğru teşhis edilmesine bağlıdır. Bu gerçek doğrultusunda teşhis sürecinde başvurulan yöntemlerin etkinliğini değerlendirmeyi amaçladık.
Gereç ve yöntemler
2016-2022 yılları arasında akut apandisit ön tanısı değerlendirilen 488 hastanın muayene labaratuvar ve görüntüleme sonuçları analiz edildi. En az 48 saattir devam eden karın ağrısı tüm hastaların ortak özelliği idi. Dahil edilme kriterlerinde başka bir merkezde görüntüleme yapılmamış ve medikal tedavi başlanmamış olması vardı. Hariç tutulma kriterleri ise sırasıyla: 15 yaşından küçük olmak, bilinen malignite, ailevi akdeniz ateşi, pelvik inflamatuar hastalık, sistit ve gebelik ile geçirilmiş batın cerrahisi idi. İlk muayene sonrası takip kararı alınan 162 hasta (Non-surgery group) ile cerrahi müdahale kararı verilen 326 hasta (Surgery group) iki ayrı grupta irdelendi. Yaş, cinsiyet ve ultrasonografi ile iştahsızlık, ateş, ağrının lokalizasyonu, ağrının migrasyonu, rebound bulgusu, bulantı-kusma, lökositoz, akut faz yanıtında sola kayma gibi Alvarado parametreleri yönünden karşılaştırıldı. Opere edilen hastaların final patolojileri kendi içinde değerlendirildi.
Bulgular
Surgery Group(SG) ta kadınların %87’si, erkeklerin %94,3’ü apandisit idi (p=0.02). Alvarado sisteminde, ameliyat kararını ön gördüren en önemli parametre anoreksi olarak tespit edildi (p<0.001). Alvarado skoru, yaş, cinsiyet ve ultrasonografi sonuçlarının dahil edildiği regresyon analizinde, ultrasonografinin ameliyatı ön gördürmede istatistiksel olarak anlamlı olmadığı (p=0.6), Alvarado skorunun ise bu bakımdan değerli olduğu gözlendi (p<0.001). SG’nin regresyon analizinde, ateş (p<0.001), lökositoz (p=0.001), ve rebound (p=0.016) akut apandisiti ön gördürmede önemliydi. Bu grupta ultrasonografi de benzer etkinliğe sahipti. Ultrasonografinin akut apandisiti desteklemesi, kati patoloji sonucunun apandisit olarak raporlanması ihtimalini 1,9 kat arttırmaktaydı.
Sonuç
Akut apandisit ön tanısı ile konsülte edilen hastalarda ameliyat kararı üzerinde fizik muayene bulguları önemlidir. Bu amaçla erkeklerde daha güvenli olan Alvarado skorlama sisteminin kullanılması negatif apendektomi oranlarını azaltmakta, tanıda gecikme ihtimalini düşürmektedir.
Anahtar Kelimeler
Teşekkür
Hastanemiz bilgi işlem sistemi çalışanlarına teşekkür ederiz.
Kaynakça
- Anderson JE, Bickler SW, Chang DC, Talamani MA.Examining a Common Disease with Unknown Etiology:Trends in Epidemiology and Surgical Management ofAppendicitis in California, 1995-2009. World J Surg. 2012;36: 2787-94. DOI: 10.1007/s00268-012-1749-z
- Song H, Abnet CC, Andrén-Sandberg A, Chaturvedi AK, YeW.Risk of gastrointestinal cancers among patients withappendectomy: a large-scale Swedish register-based cohortstudy during 1970-2009. PloS One. 2016;11(3):0151262 DOI:10.1371/journal.pone.0151262.
- Prystowsky JB, Pugh CM, Nagle AP. Current problems insurgery. Appendicitis. Curr Probl Surg. 2005;42: 668-742. DOI: 10.1067/j.cpsurg.2005.07.005.
- Reddy SB, Kelleher M, Bokhari SAJ, Davis KA, Schuster KM.A highly sensitive and specific combined clinical and sonographic score to diagnose appendicitis. J Trauma AcuteCare Surg. 2017 Oct;83(4):643-649. DOI:10.1097/TA.0000000000001551.
- Livingston EH, Woodward WA, Sarosi GA, Haley RW.Disconnect Between Incidence of Nonperforated andPerforated Appendicitis: Implications for Pathophysiologyand Management. Annals of Surgery: June 2007- Volume245- Issue 6- p 886-892 DOI:10.1097/01.sla.0000256391.05233.aa
- Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V.Changing epidemiology of acute appendicitis in the UnitedStates: study period 1993-2008. J Surg Res 2012;175(2):185–90.DOI: 10.1016/j.jss.2011.07.017.
- Al-Hashemy AM, Seleem MI. Appraisal of the modifiedAlvarado Score for acute appendicits in adults. Saudi medicaljournal. 2004;25(9):1229-1231.
- Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis:2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(1):27. DOI:10.1186/s13017-020-00306-3
- Hoffman J, Rasmussen OO. Aids in the diagnosis of acuteappendicitis. Br J Surg 1989; 76:774-9. DOI:10.1002/bjs.1800760803.
- Tan WJ, Acharyya S, Chew MH, Foo FJ, Chan WH, Wong WK, et al. Randomized control trial comparing an AlvaradoScore-based management algorithm and current best practicein the evaluation of suspected appendicitis. World J EmergSurg. 2020 May 1;15(1):30. DOI: 10.1186/s13017-020-00309-0.
- Lone NA, Shah M, Wani KA, Peer GQ. Modified Alvarado score in diagnosis of acute appendicitis. Ind J Pract Dr. 2006;3:1–4.
- Jan HI, Khan J. Evaluation of modified Alvarado score inthe diagnosis of acute appendicitis. Pak J Surg.2007;23(4):248–50.
- Doria AS. Optimizing the role of imaging in appendicitis.Pediatr Radiol 2009;39(2): S144–8. DOI: 10.1007/s00247-008-1105-5.
- Crnogorac S, Lovrenski J. Validation of the Alvarado scorein the diagnosis of acute appendicitis. Med Pregl 2001; 54:557-61.
- Flexer SM, Tabib N, Peter MB. Suspected appendicitis in pregnancy. Surgeon 2014;12(2): 82–6. DOI:10.1016/j.surge.2013.11.022.
- Lee SL, Stark R, Yaghoubian A, Shekherdimian S, Kaji A.Does age affect the outcomes and management of pediatricappendicitis? J Pediatr Surg. 2011;46(12): 2342-2345 DOI:10.1016/j.jpedsurg.2011.09.030.
- Colvin JM, Bachur R, Kharbanda A. The presentationofappendicitis in preadolescent children. Pediatr Emerg Care.2007;23(12):849-855. DOI: 10.1097/pec.0b013e31815c9d7f.
- Sheu BF, Chiu TF, Chen JC, Tung MS, Chang MW, YoungYR. Risk factors associated with perforated appendicitis inelderly patients presenting with signs and symptoms of acuteappendicitis. ANZ J Surg. 2007;77(8):662-666. DOI:10.1111/j.1445-2197.2007.04182.x.
- Young YR, Chiu TF, Chen JC, Tung MS, Chang MW, Chen JH, et al. Acute appendicitis in the octogenarians and beyond:a comparison with younger geriatric patients. Am J Med Sci.2007;334(4):255-259. DOI: 10.1097/MAJ.0b013e3180ca8eea.
- Denizbasi A, Unluer EE. The role of the emergency medicine resident using the Alvarado score in the diagnosis of acuteappendicitis compared with the general surgery. Eur J EmergMed 2003; 10:296-301. DOI: 10.1097/00063110-200312000-00011.
- Garcia-Aguayo FJ, Gil P. Sonography in acute appendicitis:diagnostic utility and influence upon management andoutcome. Eur Radiol 2000; 10:1886-93. DOI:10.1007/s003300000521.
- Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, et al. Accuracy of ultrasonography in the diagnosis of acuteappendicitis in adult patients: review of the literature. CritUltrasound J 5 (Suppl 1), S2 (2013) DOI: 10.1186/2036-7902-5-S1-S2
- Giljaca V, Nadarevic T, Poropat G, Naderevic VS, StimacD.Diagnostic Accuracy of Abdominal Ultrasound forDiagnosis of Acute Appendicitis: Systematic Review and Meta- analysis. World J Surg 2017 Mar;41(3):693-700 DOI:10.1007/s00268-016-3792-7
- Ford RD, Passinault WJ, Morse ME. Diagnostic ultrasoundfor suspected appendicitis: does the added cost produce a better outcome? Am Surg 1994; 60:895-8.
- Pedro Lourenco, Jacquie Brown, Jonathan Leipsic, Cameron Hague. The current utility of ultrasound in the diagnosis ofacute appendicitis. Clinical Imaging 2016; 40(5):944-948, DOI: 10.1016/j.clinimag.2016.03.012.
Öz
Abstract
Background
Acute appendicitis is one of the most common causes of acute abdomen. In case of delay in the diagnosis process, perforation develops, and the patient's morbidity and mortality increase. In our study, we evaluated the effectiveness of laboratory, radiological, and physical examination findings in diagnosing acute appendicitis.
Methods
A total of 488 patients hospitalized with a prediagnosis of acute appendicitis were included in the study. 162 patients constituted the unoperated and 326 patients constituted the operated group (Groups 1 and 2). The two groups were compared in terms of age, gender, and ultrasonographic findings, as well as Alvarado score parameters.
Results
In logistic regression analysis, which included only Alvarado parameters, anorexia was the most valuable parameter in predicting surgery (p=0.000). The Alvarado score was found to be the most useful parameter in making the surgery decision (p<0.001). In the regression model in which only Alvarado parameters were included, the most critical parameters in predicting acute appendicitis were fever (p<0.001), leukocytosis (p=0.001), rebound (p=0.016) and migration of pain to the right lower quadrant (p=0.04). When the Alvarado score was compared with other parameters in group 2, ultrasonographic positivity was at least as predictive as Alvarado positivity. While 87% of operated women had appendicitis, 94.3% of men had appendicitis (Chi-square p=0.02).
Conclusion
The clinic of the patient is more important than the laboratory and radiological findings in making the surgery decision in patients consulted with a preliminary diagnosis of acute appendicitis. Using the Alvarado scoring system at this stage will reduce negative appendectomy rates.
Anahtar Kelimeler
Acute appendicitis Alvarado score ultrasonography physical examination
Kaynakça
- Anderson JE, Bickler SW, Chang DC, Talamani MA.Examining a Common Disease with Unknown Etiology:Trends in Epidemiology and Surgical Management ofAppendicitis in California, 1995-2009. World J Surg. 2012;36: 2787-94. DOI: 10.1007/s00268-012-1749-z
- Song H, Abnet CC, Andrén-Sandberg A, Chaturvedi AK, YeW.Risk of gastrointestinal cancers among patients withappendectomy: a large-scale Swedish register-based cohortstudy during 1970-2009. PloS One. 2016;11(3):0151262 DOI:10.1371/journal.pone.0151262.
- Prystowsky JB, Pugh CM, Nagle AP. Current problems insurgery. Appendicitis. Curr Probl Surg. 2005;42: 668-742. DOI: 10.1067/j.cpsurg.2005.07.005.
- Reddy SB, Kelleher M, Bokhari SAJ, Davis KA, Schuster KM.A highly sensitive and specific combined clinical and sonographic score to diagnose appendicitis. J Trauma AcuteCare Surg. 2017 Oct;83(4):643-649. DOI:10.1097/TA.0000000000001551.
- Livingston EH, Woodward WA, Sarosi GA, Haley RW.Disconnect Between Incidence of Nonperforated andPerforated Appendicitis: Implications for Pathophysiologyand Management. Annals of Surgery: June 2007- Volume245- Issue 6- p 886-892 DOI:10.1097/01.sla.0000256391.05233.aa
- Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V.Changing epidemiology of acute appendicitis in the UnitedStates: study period 1993-2008. J Surg Res 2012;175(2):185–90.DOI: 10.1016/j.jss.2011.07.017.
- Al-Hashemy AM, Seleem MI. Appraisal of the modifiedAlvarado Score for acute appendicits in adults. Saudi medicaljournal. 2004;25(9):1229-1231.
- Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis:2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(1):27. DOI:10.1186/s13017-020-00306-3
- Hoffman J, Rasmussen OO. Aids in the diagnosis of acuteappendicitis. Br J Surg 1989; 76:774-9. DOI:10.1002/bjs.1800760803.
- Tan WJ, Acharyya S, Chew MH, Foo FJ, Chan WH, Wong WK, et al. Randomized control trial comparing an AlvaradoScore-based management algorithm and current best practicein the evaluation of suspected appendicitis. World J EmergSurg. 2020 May 1;15(1):30. DOI: 10.1186/s13017-020-00309-0.
- Lone NA, Shah M, Wani KA, Peer GQ. Modified Alvarado score in diagnosis of acute appendicitis. Ind J Pract Dr. 2006;3:1–4.
- Jan HI, Khan J. Evaluation of modified Alvarado score inthe diagnosis of acute appendicitis. Pak J Surg.2007;23(4):248–50.
- Doria AS. Optimizing the role of imaging in appendicitis.Pediatr Radiol 2009;39(2): S144–8. DOI: 10.1007/s00247-008-1105-5.
- Crnogorac S, Lovrenski J. Validation of the Alvarado scorein the diagnosis of acute appendicitis. Med Pregl 2001; 54:557-61.
- Flexer SM, Tabib N, Peter MB. Suspected appendicitis in pregnancy. Surgeon 2014;12(2): 82–6. DOI:10.1016/j.surge.2013.11.022.
- Lee SL, Stark R, Yaghoubian A, Shekherdimian S, Kaji A.Does age affect the outcomes and management of pediatricappendicitis? J Pediatr Surg. 2011;46(12): 2342-2345 DOI:10.1016/j.jpedsurg.2011.09.030.
- Colvin JM, Bachur R, Kharbanda A. The presentationofappendicitis in preadolescent children. Pediatr Emerg Care.2007;23(12):849-855. DOI: 10.1097/pec.0b013e31815c9d7f.
- Sheu BF, Chiu TF, Chen JC, Tung MS, Chang MW, YoungYR. Risk factors associated with perforated appendicitis inelderly patients presenting with signs and symptoms of acuteappendicitis. ANZ J Surg. 2007;77(8):662-666. DOI:10.1111/j.1445-2197.2007.04182.x.
- Young YR, Chiu TF, Chen JC, Tung MS, Chang MW, Chen JH, et al. Acute appendicitis in the octogenarians and beyond:a comparison with younger geriatric patients. Am J Med Sci.2007;334(4):255-259. DOI: 10.1097/MAJ.0b013e3180ca8eea.
- Denizbasi A, Unluer EE. The role of the emergency medicine resident using the Alvarado score in the diagnosis of acuteappendicitis compared with the general surgery. Eur J EmergMed 2003; 10:296-301. DOI: 10.1097/00063110-200312000-00011.
- Garcia-Aguayo FJ, Gil P. Sonography in acute appendicitis:diagnostic utility and influence upon management andoutcome. Eur Radiol 2000; 10:1886-93. DOI:10.1007/s003300000521.
- Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, et al. Accuracy of ultrasonography in the diagnosis of acuteappendicitis in adult patients: review of the literature. CritUltrasound J 5 (Suppl 1), S2 (2013) DOI: 10.1186/2036-7902-5-S1-S2
- Giljaca V, Nadarevic T, Poropat G, Naderevic VS, StimacD.Diagnostic Accuracy of Abdominal Ultrasound forDiagnosis of Acute Appendicitis: Systematic Review and Meta- analysis. World J Surg 2017 Mar;41(3):693-700 DOI:10.1007/s00268-016-3792-7
- Ford RD, Passinault WJ, Morse ME. Diagnostic ultrasoundfor suspected appendicitis: does the added cost produce a better outcome? Am Surg 1994; 60:895-8.
- Pedro Lourenco, Jacquie Brown, Jonathan Leipsic, Cameron Hague. The current utility of ultrasound in the diagnosis ofacute appendicitis. Clinical Imaging 2016; 40(5):944-948, DOI: 10.1016/j.clinimag.2016.03.012.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Cerrahi, Acil Tıp |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 21 Ağustos 2023 |
| Gönderilme Tarihi | 30 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 3 Sayı: 2 |
e-ISSN: 2791-9935