Ultrasonography and clinical observation in women with suspected acute appendicitis: a prospective cohort study.
OBJECTIVE
It was the aim of this study to evaluate the role of ultrasonography (US) and clinical observation in non-pregnant women of reproductive age with suspected appendicitis.


METHODS
In a prospective cohort study, US was performed in 234 women with suspected appendicitis. Based on US findings and clinical assessment, 3 patient categories were established. Group A: unequivocal signs--laparoscopy (regardless of US results); group B: equivocalsigns--positive US--laparoscopy; group C: equivocal signs--negative US--observation. US results were compared with surgery, observation and follow-up as the reference standard.


RESULTS
The percentages of macroscopically infected appendices at laparoscopy in groups A, B and C were 76, 55 and 5%, respectively. Group A: US was false negative in 27 of 128 women (21%) and false positive in 12 of 40 women (30%). Group B plus C: US was false negative in 3 of 9 women (33%) and false positive in 5 of 57 women (9%). Forty-six of 55 patients (84%) completed observation.


CONCLUSIONS
Because of a high false-negative rate, US as a sole imaging tool is of limited value both in women with unequivocal and equivocal signs of appendicitis. Observation is safe in women with equivocal signs of appendicitis.
Poortman
Pieter
P
Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands. ppoortman@wlz.nl
Oostvogel
Henk
H
Lohle
Paul
P
Cuesta
Miguel
M
de Lange-de Klerk
Elly
E
Hamming
Jaap
J
D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D011446:Prospective Studies; D014463:Ultrasonography; D055815:Young Adult