Increasing accuracy in the diagnosis of acute appendicitis with modern diagnostic techniques.

One hundred consecutive patients admitted to the hospital with the prospective diagnosis of appendicitis were evaluated retrospectively to determine the effect of the use of modern diagnostic techniques upon the accuracy of preoperative diagnosis. Appendectomy was performed on 48 patients. In three of these patients, the diagnostic process was assisted by the use of radiologic or ultrasound techniques. Of the 52 patients who did not undergo appendectomy, 13 patients clearly avoided surgery or were steered towards an other appropriate operative procedure due to findings on ultrasound or barium enema. Ultrasound was particularly useful in differentiating the etiology of right lower quadrant pain in the childbearing aged female. This study demonstrates that the traditionally expected 15% normal appendix rate can be narrowed (6.25% in this group of patients) without increasing morbidity, with the use of sophisticated diagnostic techniques in the evaluation of selected patients who present diagnostic dilemmas.