The Impact of Routine CT Scan for Acute Appendicitis on the Negative Appendectomy Rate: Clinical Audit of a Single Center

Abstract

Background: Acute appendicitis remains the most common surgical emergency worldwide. Patient usually presents with abdominal pain mainly right lower, which gives tenderness on examination. This may or may not be associated with raised inflammatory markers. CT scan is nowadays routinely done in accident and emergency room, which leads to the confirmation of symptoms presented as acute appendicitis. Appendectomy is done at earliest and the specimen sent for histopathology. Some appendixes are obviously inflamed, but some are found borderline which only confirms after the histopathology report. Removing a normal appendix means negative appendectomy will be determined on final histopathology report.

Aim: The aim of this study is to determine the negative appendectomy rate in Mediclinic City Hospital Dubai, where CT scan is routinely done for all patients with clinical suspicion of acute appendicitis. Patients and Methods: Data from 2010 till 2018 of patients who underwent emergency appendectomy was collected. Total of 407 patients were included in the study, age ranges between 14 - 70 years and the average was 36.76 (SD). Children and pregnant were excluded from the study.

Result: Negative appendectomy rate in our hospital was found to be (no) 6.1%, 25 patients out of 407 were not found as acute appendicitis on histology. Of the 25 patients, 9 (2.2%) were found to have other diagnoses. The mean age was 36.76 (10.97). To that concern the gender, 225 (55.3%) were males and 182 (44.7%) were females. Out of the total only 30 (7.4%) patients did not undergo CT scan due to unknown reasons.

Conclusion: Negative appendectomy rate has declined globally over the period of time due to increased use of imaging modalities, mainly CT scan, but still some cases are picked up which does not confirm on histology. Our hospital has a low rate of negative appendectomy due to the routine use of CT scan in the diagnosis of acute appendicitis. Hence we decided to share our experience.