title: Clinical utility of abdominal and pelvic ultrasound in the evaluation of right iliac fossa pain in females.
abstract: BACKGROUND
  Ultrasound (US) is often the imaging modality of choice in women with acute right iliac fossa (RIF) pain, identifying the appendix in up to 99% of patients. The literature, however, lacks clear guidelines on how ultrasonography should be performed to maximise sensitivity and specificity in such patients. Many centres perform untargeted abdomino-pelvic scans, including organs such as the liver and spleen, which unlikely contribute to the presenting complaint.
  
  
  OBJECTIVE
  We aimed to evaluate the clinical utility of unfocussed abdominal and pelvic US in women of reproductive age with acute RIF pain.
  
  
  METHODS
  This multicentre study describes 501 women between the ages of 12 and 50, over a 3-year period from three institutions, presenting acutely with RIF pain and investigated with US abdomen and pelvis.
  
  
  RESULTS
  5.9% of cases confirmed appendicitis sonographically. A normal appendix was visualised in 0.2%. Over 10% identified gynaecological pathology, 41% relating to the right ovary. 10.4% incidental extra-pelvic findings were unrelated to the acute clinical presentation. 0.8% of patients had extra-pelvic findings meriting further clinical assessment.
  
  
  CONCLUSIONS
  The results herein reflect findings from high volume emergency surgical departments, demonstrating that unfocussed abdominal and pelvic ultrasounds are not an appropriate use of resources in reproductive women with RIF pain. Clinically relevant extra-pelvic US findings account for less than 1%, rarely contributing to the acute presentation. The appendix was only visualised in 6% of patients, suggesting that a focussed appendiceal and pelvic US would better assist diagnosis with a higher yield and increased sensitivity and specificity.
authors.affiliation: Department of General Surgery, University Hospital Kerry, Tralee, County Kerry, Republic of Ireland. olasdahmed@gmail.com.
authors.forename: O
authors.initials: O
authors.lastname: Ahmed
authors.affiliation: Department of General Surgery, University Hospital Kerry, Tralee, County Kerry, Republic of Ireland.|Department of General Surgery, University Hospital Waterford, Waterford, Republic of Ireland.|Department of General Surgery, St Luke's Hospital Kilkenny, Kilkenny, Republic of Ireland.
authors.forename: A C
authors.initials: AC
authors.lastname: Rogers
authors.affiliation: Department of General Surgery, St Luke's Hospital Kilkenny, Kilkenny, Republic of Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Balfe
authors.affiliation: Department of General Surgery, University Hospital Kerry, Tralee, County Kerry, Republic of Ireland.
authors.forename: B M
authors.initials: BM
authors.lastname: Waldron
authors.affiliation: Department of General Surgery, St Luke's Hospital Kilkenny, Kilkenny, Republic of Ireland.
authors.forename: F
authors.initials: F
authors.lastname: Pretorius
authors.affiliation: Department of General Surgery, University Hospital Waterford, Waterford, Republic of Ireland.
authors.forename: M P
authors.initials: MP
authors.lastname: McMonagle
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D015746:Abdominal Pain / Q000209:etiology* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000473:pathology; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: Appendicitis; Pelvic ultrasound; Right iliac fossa pain