An appendix inflammation is referred to as appendicitis. A worm-shaped object is referred to as a "vermiform" in Latin. A literal definition of an appendix is an appendage which is joined to a major or larger part, like a tail or limb. The caecum gives rise to the worm-shaped tubular structure known as the vermiform appendix. When all ages are considered, the current mortality rate is 0.25% due to the availability of improved antisepsis, antibiotics, and good diagnostic techniques. 1,2

Nowadays, surgery is the go-to treatment for AA because of its high success rate as well as low rate of complications.

Early appendectomy eventually gained acceptance as the gold standard of care, with a wide range of grounds to avoid perforation.

After the adverse effects of a significant number of negative appendectomies were identified in the 1970s, interest began to gradually move toward a more conservative management3 Across the world, appendectomies are still among the most frequently done surgeries. The most frequent cause of appendectomy is acute appendicitis.

The uneven clinical presentation often results in a misdiagnosis of AA in 1 out of 5 patients and a negative appendectomy rate of 15–40%. Furthermore, only 50–60% of patients exhibit the "classic" symptomatology, which makes diagnosis even more challenging.

ULTRASONOGRAPHY (USG)4 When performed by a trained professional, ultrasonography can detect an enlarged appendix in patients who have unclear results or in women who may have pelvic pathology. Nonetheless, the range of the overall positive as well as negative predictive values is between 80% and 100%. USG may be the preferred imaging test for patients, such as children and pregnant women, for whom limiting radiation exposure is desirable, despite its inferior accuracy compared to CT scanning. It has been suggested that a trustworthy diagnostic method for AA is graded compression USG. This low-cost, fast-acting technique doesn't require contrast and can be applied to patients who are pregnant. According to reports, the sensitivity ranges “from 78% - 83%, and the specificity ranging from 83 percent to 93 percent.

Ultrasonography is used in the Tzanakis score along with laboratory results and clinical evaluation. Nicolaos E. Tzanakis introduced it for the first time in 2005 at the Medical School of Athens University in Greece. A total score of 15 is used to analyze acute appendicitis using four parameters. An acute case of appendicitis requiring immediate surgery is indicated by a score of 8 or higher.5 Hence this study was conducted to assess the efficacy of Ultrasound of Abdomen and Pelvis in diagnosing acute appendicitis.

The Prospective comparative observational study includes patients who underwent surgery for acute appendicitis (AA) after presenting to the General Surgery Department of the SDM College of Medical Sciences and Hospital in Sattur, Dharwad. The study was conducted over a year at SDMCMSH in Dharwad between October 2022 to October 2023. Ethical clearance was obtained from SDM Instituitional Ethic Committee on 27/07/2022, reference number- SDMIEC/2022/273

Instead of relying only on the scores, the operating surgeon used their overall clinical judgment to decide whether to perform surgery. The information gathered was employed to compute the Alvarado and Tzanaki scores. The results of the histology were monitored after the appendectomy.

SAMPLE SIZE: 85

INCLUSION CRITERIA-

• Patients aged 15 and above diagnosed with acute appendicitis undergoing open/laparoscopic appendectomy in SDMCMSH during the study period
• Patient willing to participate and give consent for the research

EXCLUSION CRITERIA-

• The patient is not willing for surgery.
• Appendicular mass.
• Peritonitis secondary to appendicular perforation

METHODS:

• Informed consent taken prior to the study
• At the time of admission, each patient had undergone a comprehensive history and a thorough clinical examination and recorded on preformed profoma.
• Relevant investigations were done
• USG Abdomen and pelvis done on admission.
• Prior to surgery and at the time of admission, each patient was given both the Tzanaki Score and the Alvarado Score.
• Surgery was performed on patients whose scores were below the cutoff points based on clinical judgment and assessment.
• Patients underwent either an emergency open or laparoscopic appendectomy, or they received conservative management.
• The final diagnosis was validated by the pathologist's histopathological examination of the specimen.
• The data was compared between the two score systems' diagnostic accuracy for acute appendicitis.
• SONOGRAPHIC CRITERIA FOR APPENDICITIS
• Appendix noncompressible with AP diameter greater than 6 mm
• Hyperechoic thickened appendix wall > 2 mm—target sign.
• Appendicolith Presence.
• Discontinuity of the submucosal layer.
• Peri-appendicular” fluid.

Statistical Analysis: Excel and SPSS software version 21 are used for data analysis. A frequency table is used to present categorical variables. The form for continuous variables is Mean ± SD/Median (Min, Max). The applicability “of the Tzanakis score, and Alvarado score to predict acute appendicitis is checked by Logistic regression and Receiver Operating Characteristic (ROC) curves. By simultaneously maximizing the sensitivity and specificity, cutoff values are determined.Statistical significance is indicated by a P-value of” 0.05 or less.

Data contains measurements of 85 subjects with acute appendicitis whose age ranges from 15 – 73 years.

Table 1: Distribution of subjects according to demographic details.

The subjects' mean age was 30.86 ± 11.87 years. Out of 85 subjects, 40 (47.1%) were female and 45 (52.9%) were male.

Figure 1: Distribution of subjects according to gender.

Table 2: Distribution of subjects according to Clinical findings.

Out of 85 (100%) subjects, 85 (100%) had Right lower quadrant tenderness, 27 (31.8%) had Rebound tenderness, 22 (25.9%) had Migratory right lower quadrant pain, 56 (65.9%) had Nausea/vomiting, 23 (27.1%) had Anorexia, 37 (43.5%) had Fever, 49 (57.6%) had Leucocytosis, 12 (14.1%) had Shift to left, 85 (100%) had Right lower quadrant tenderness, 26 (30.6%) had Rebound tenderness, 50 (58.8%) had Leucocytosis and 70 (82.4%) had USG positive findings.

Table 3: Distribution of subjects according to clinicodemographic characteristics and ultrasonography findings in histopathological positive and negative appendicitis

It can be observed that USG detected appendicular inflammation in 67 (78.8%) subjects. 3 (3.5%) were not detected positive in USG.

It can be observed that, based on Tzanakis scores, out of 85 subjects 68 (80%) were found to have HP acute appendicitis

Table 4- Correlation between ultrasonography (USG) and histopathological examination (HPE) findings

The sensitivity of USG is 91.78%, and its specificity is 75.0% with a diagnostic accuracy of 89.41%

Acute appendicitis mimics a variety of other intra-abdominal conditions, making it difficult for the surgeon to make a confident preoperative diagnosis. A number of scoring systems with various parameters have been created to help enhance diagnostic accuracy since consequences can arise from delayed diagnosis.

In the past, in order to prevent complications, a high percentage of 15%–20% negative appendectomy has been approved. However, morbidities such as fecal fistula, adhesions, future hernias, and surgical site infections were not equally related to the mortality of negative appendectomy. These rationales indicate that increasing accuracy in diagnosis will help reduce the need for negative appendectomy.

A number of laboratory indicators “of inflammation, including leucocytosis and elevated C reactive protein, imaging tests like USG or CT, and laparoscopy are essential to the diagnosis of AA. This set of resources certainly improved diagnostic precision and contributed to a decrease in the negative appendectomy rate. But these methods aren't accessible universally.

TABLE 5: COMPARISON OF GENDER-WISE DISTRIBUTION OF PATIENTS OF THE PRESENT STUDY WITH OTHER STUDIES

In this table, the present study is closely related to the Sharma D et al.

TABLE 6: COMPARISON OF AGE-WISE DISTRIBUTION OF PATIENTS OF THE PRESEN STUDY WITH OTHER STUDIES

In this table, the mean age of presentation in the present study is closely related to the Shashikala V, Harsha Hegde et al study.

TABLE 7: COMPARISON OF THE MOST COMMON SYMPTOM OF PATIENTS OF THE PRESENT STUDY WITH OTHER STUDIES

In this table, the present study is closely related to the Sharma D et al study where the more common presenting system was right lower quadrant tenderness followed by nausea/vomiting (65.9%)

In the current study out of 85 subjects, 70(82.4%) were found to have features of acute appendicitis on the USG abdomen and pelvis. Of these, 67 (78.8%) has AA on Histopathological report. The sensitivity of USG is 91.78%, and its specificity is 75.0% with a diagnostic accuracy of 89.41%

1. Blomqvist PG, Anderson REB, Granath F, et al. Mortality after appendectomy in Sweden, 1987–1996. Ann Surg. 2001;233:455–60.
2. Hale DA, Molloy M, Pearl RH, et al. Appendectomy: A contemporary appraisal. Ann Surg. 1997;225:252–61.
3. A sound approach to the diagnosis of acute appendicitis (Editorial). Lancet. 1987;1:198–200.
4. Masek T, Poulová M, Schwarz J, Bavor P. [Ultrasonography as an auxiliary method in diagnosis of acute appendicitis]. Rozhl Chir. 2003;82(6):320–3.
5. Tzanakis NE, Efstathiou SP, Danulidis K, Rallis GE, Tsioulos DI, Chatzivasiliou A, et al. A new approach to accurate diagnosis of acute appendicitis. World J Surg. 2005;29(9):1151–6.
6. Anupriya R, Ganesh Babu CP, Rajan KV. A comparison of Tzanakis and Alvarado scoring system in the diagnosis of acute appendicitis. Int Surg J. 2019;6:2080–3.
7. Shashikala V, Hegde H, Victor AJ. Comparative study of Tzanakis score vs Alvarado score in the effective diagnosis of acute appendicitis. Int J Biomed Adv Res. 2016;7(9):418–20.
8. Sigdel GS, Lakhey PJ, Mishra PR. Tzanakis score vs. Alvarado score in acute appendicitis. JNMA J Nepal Med Assoc. 2010;49:96–9.