Acute appendicitis is the most common acute surgical condition of the abdomen, But the diagnostic accuracy was not high and the frequent removal of normal appendixes was, often, at times, approaching 20 percent of all appendecotomies. Recently,
barium
enema has been helpful in increasing the accuracy of diagnosis in difficult cases.
To improve our diagnostic acumen and lower incidence of the removal of normal appendixes and evaluate the diagnostic value, especially in young women and patient with severe illnesses, a prospective study with the use of diagnostic barium enema
was
undertaken. From May 1990 to June 1991, 154 patients were evaluated under the impression of acute appendicitis. Abdominal exploration without barium enema was performed in 57 patients. Barium enema was performed in 97 patients, because of an
obscure
clinical presentation, a known associated condition or to evaluate the diagnostic value.
In interpretation of the barium enema. We divided three groups: Positive findings; non-filling or partial filling of appendix with extrinsic compression of cecum or terminal ileum. or cecal, ileal irritability, Partial filling with 'cut-off'
sign.
Suspicious findings; non-filling or partial filling of appendix with no evidence of associated positive findings.
Negative findings; normal filling of appendix without other positive findings.
1) Abdominal exploration without bariumenema was performed in 57 patients and normal appendixes were removed in 9 cases(15.8%).
2) Negative findings were in 43 patients. Negative frequency was 61.4% in women(N=44) and 30.2% in man(N=53). This group were not explored in any patients as appendicitis and 0% in false negative.
3) positive findings were in 30 patients, with 93.3% in sensitivity and 6.7% in false postive.
4) Suspicious findings were in 24 patients, with 62.5% in sensitivity and 37.5% in false positive.
5) The overall diagnostic accuracy was 95.9%, sensitivity 91.5%, specificity 92.6%, false positive 8.5%, false negative 0% and normal appendixes were removed in 4 cases(8.7%) and negative exploration was done in 3 cases(6.5%).
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