Computed Tomography Scan for Minimising the Rate of Negative Appendectomy in Patients Suffering from Acute Right Lower Abdominal Pain

Introduction: Diagnosis and management of right lower abdominal pain which is frequently due to appendicitis, is still a subject of continuous study. The correct diagnosis will decrease the frequency of negative surgery with a decline in days of hospital stay and leads to the direction of health funds towards the proper target. Aim: To evaluate the efficiency of Computed Tomography (CT) scan in diagnosing the patients presenting with acute pain at the lower right abdominal quadrant and its chance for diminishing the rate of negative appendectomy in these patients. Materials and Methods: This study included 238 consecutive patients suffering from acute pain in the right lower abdominal quadrant. All patients underwent clinical, laboratory, and radiological evaluation. The abdominal Ultrasonography (USG), and then a CT done in all cases. Laparoscopy was not available in our emergency operating theatre, so diagnostic laparoscopy was not possible and laparotomy was done for the 238 patients as they had a suspicion of the need for surgical intervention. The harvested specimens sent for histological examination. We excluded from our study the patients who were generally stable with mild or no abdominal manifestations, as well as with the negative USG and/or CT, they kept for 48 hours under observation and then discharged on symptomatic treatment, contact number for communicating in cases of recurrent symptoms, and follow-up in the outpatient clinic. Data were collected and statistically analysed. Results: Appendectomy performed in 238 cases, out of them 105 were males and 133 were females. Considering histopathological diagnosis as the gold standard, preoperative CT showed a significantly higher test validity characters in comparison to the abdominal USG and clinical examination with a sensitivity of 94.3%, a specificity of 91%. On the other hand, USG showed a sensitivity rate of 77.4%, a specificity rate of 76%. Clinical examination showed a sensitivity rate of 74.8%, a specificity rate of 69.6%. Conclusion: The preoperative CT for patients suffering acute pain in the lower right abdominal region; is highly recommended in suspicious cases and it diminishes the rate of unnecessary laparotomies when the diagnostic laparoscopy is not possible as well as it improves the true positive surgical rate.