ROLE OF ULTRASONOGRAPHY IN EVALUATION OF ACUTE APPENDICITIS: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Acute appendicitis is one of the most common causes of acute abdomen requiring emergency surgical 
intervention. Early and accurate diagnosis is essential to prevent complications such as perforation, abscess formation, 
and peritonitis. Ultrasonography is a safe, non-invasive, widely available, and cost-effective imaging modality used in 
the evaluation of clinically suspected acute appendicitis. 
Aim: To evaluate the diagnostic accuracy of ultrasonography in patients clinically suspected to have acute appendicitis. 
Methods: A prospective observational study was conducted in the Department of Radiodiagnosis during 2012 among 
130 patients clinically suspected to have acute appendicitis. Patients presenting with right iliac fossa pain and clinical 
suspicion of appendicitis were included. Patients with previous appendectomy, pregnancy, generalized peritonitis 
requiring immediate surgery, and incomplete records were excluded. Detailed clinical history and examination findings 
were recorded. Ultrasonography was performed using graded compression technique. Sonographic parameters including 
appendiceal diameter, compressibility, periappendiceal collection, appendicolith, and fat stranding were assessed. 
Ultrasonographic findings were compared with operative and histopathological diagnosis. Sensitivity, specificity, positive 
predictive value, and negative predictive value were calculated.  
Results: The mean age of participants was 28.6 ± 11.2 years. Male predominance was observed, and the majority of 
patients belonged to the 21–40-year age group. Right iliac fossa pain was present in all patients, followed by nausea or 
vomiting, rebound tenderness, fever, and anorexia. Enlarged noncompressible appendix was the most common 
ultrasonographic finding, followed by increased periappendiceal echogenicity and periappendiceal fluid collection. 
Ultrasonography showed sensitivity of 90.2%, specificity of 71.4%, positive predictive value of 92.0%, and negative 
predictive value of 66.7%. Delayed presentation beyond 48 hours was significantly associated with appendicular 
perforation, appendicular abscess, and localized peritonitis. 
Conclusion: Ultrasonography is an effective, safe, and reliable imaging modality for evaluating suspected acute 
appendicitis. It provides high sensitivity and positive predictive value when combined with clinical assessment. Early 
diagnosis using ultrasonography may help reduce negative appendectomy, delayed intervention, and complications related 
to acute appendicitis.