الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute appendicitis is a disease with a lengthy documented history. The standard of treatment is well established and widely accepted. This disease remains one of the most common reasons for patients to seek medical assistance in the emergency department.
Clinical decision making in cases of acute appendicitis is still a matter of debate. The approach to the problem is further highlighted by the desire to reduce the rate of misdiagnosis, to avoid unnecessary surgery on one hand and to reduce the morbidity by operating at an early stage on the other hand. Those with the typical symptoms and signs of acute appendicitis, or suspected cases with definite findings of peritonitis are promptly indicated for surgery.
Looking at the statistics of appendicitis, it is evident that the diagnosis of appendicitis remains essentially clinical even in the presence of advanced imaging techniques.
The use of US for evaluating the patient clinically suspected of having appendicitis has been extensively reported in the literature, however, there has been deal of great variability in the reported performance of US for the diagnosis of appendicitis.
Various factors might be considered as the causes of these variations. Because US is highly user-dependent, operator skill may be an important factor in the diagnostic accuracy of appendicitis
In the USA there is a strong consensus that CT is the best approach to diagnose acute appendicitis, with most arguments revolving around whether a complete abdominal and pelvic examination or just a ‘‘focused scan’’ should
be performed, and whether oral, rectal or intravenous (IV) contrast should be given alone or in combination.
Advantages of CT include less operator dependency than US easier visualization of a retrocecal appendix; unchanged quality of imaging, regardless of the presence of bowel gas, obesity, or severe abdominal pain and the possibility of multiplanar retrospective data reconstruction
Alvarado score is a simple non-invasive diagnostic procedure, which is reliable, safe, repeatable and economical, easy and can be used, in emergency setting, without expensive and complicated supportive diagnostic tools
The combination of the clinical scoring system and advanced imaging has been deeply influential in clinical practice.
The aim of the work was to evaluate the performance of ultrasound and CT by measuring their sensitivity and specificity in the diagnosis of acute appendicitis in low Alvarado score.
This study included 30 patients with acute lower abdominal pain suspecting acute appendicitis with low Alvarado score above 3and below 8.
All specimens of appendectomies were sent to histopathological examination and then their results were compared to the results of ultrasound and CT.
The results showed that the ultrasound has a sensitivity of 72.7%, specificity of 94.7%, accuracy of 86.7% and negative appendectomy rate of 11.11%.
The sensitivity, specificity and accuracy of CT were 100% and negative appendectomy rate of 00.0%.
Imaging studies (either ultrasound or CT) and are useful adjunct to physical and laboratory findings in these patients by decreasing hospital stay and negative appendectomy rate.