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Ultrasonography in diagnosis of acute appendicitis

Editor—Douglas et al's trial of ultrasonography in the diagnosis of acute appendicitis, and the accompanying editorial, highlight the importance of an accurate diagnosis of acute abdominal pain in the right iliac fossa and the need to avoid unnecessary appendicectomy.1,2 The results indicate that ultrasonography has little practical value in the diagnosis of acute appendicitis because of false positive and false negative results and the inability to identify alternative diagnoses. 
 
Neither article mentioned the increasing use of diagnostic laparoscopy in these cases. This technique makes an accurate diagnosis clearly; this is especially useful in female patients of any age and in elderly men, in whom diagnostic doubt is common. As well as preventing inappropriate appendicectomy, diagnostic laparoscopy defines the correct operative intervention if an alternative diagnosis necessitates surgery. If surgery is not required a definitive management plan is usually clear. A further advantage of laparoscopy is that if surgeons have appropriate training and experience the appendix can be removed laparoscopically, with advantages in patient recovery.3 
 
If the abdominal signs are sufficiently clear to indicate peritonism in the right iliac fossa in elderly patients or female patients of reproductive age there is little to be gained from ultrasonography. Laparoscopy should be undertaken and surgical intervention proceeded to as appropriate.