THE DIAGNOSTIC PROBLEMS OF ACUTE APPENDICITIS IN MILITARY MEDICAL PRACTICE

Acute appendicitis is one of the most common surgical emergencies. However acute appendicitis often mimics other acute abdominal conditions and might be difficult to diagnose. The accuracy of diagnosis has scarcely improved over decades, the negative appendicectomy rate is therefore high, typically 15-30% with most surgeons unwilling to risk missing the diagnosis. Present study aimed to assess the effectiveness of Modified Alvarado Score along with ultrasound examination for diagnosis of acute appendicitis in military medical practice. A total number of 60 patients (52 males and 8 females) presenting with signs of acute appendicitis were included in the study. The age range of the patients was 18-43 years. Patients participating in the study were divided into three groups in accordance with the value of the total Modified Alvarado Score. In 3 cases among 36 patients who underwent surgery the diagnosis was not confirmed during the subsequent histological examination of the removed appendix. Total negative appendectomy rate was 8.3%. Modified Alvarado Score showed high diagnostic significance sensitivity of 90.9% and specificity of 88.9%. The high diagnostic accuracy of Modified Alvarado Score is attributed to the fact that our study involved mainly military personnel, males at the age of 8-40. Among patients with aggregate Modified Alvarado Score of 1-4 no cases of acute appendicitis have been observed and in group of patients with aggregate Modified Alvarado Score of 8-10, there were rare cases of negative appendectomy. Management of the patients with the 5-7 range of Modified Alvarado Score still remains the most important issue. Additional instrumental examinations such as ultrasound, observation and proper clinical judgment are required in such cases to avoid diagnostic mistakes. Sensitivity of ultrasound examination was as low as 51.5%, specificity 80%, but ultrasound examination had high significance in identifying concomitant disease of the abdominal cavity. The use of Modified Alvarado Score as a 'first-pass" approach, together with additional ultrasound examination and observation in unclear clinical cases, helps to reduce negative appendectomy rate and complications associated with delayed diagnosis of acute appendicitis.