Is pelvic ultrasound useful in the clinical assessment and management of women with right iliac fossa pain? A single-centre retrospective study

• Published in: Annals of the Royal College of Surgeons of England 2024-11, Vol.106 (8), p.711-717
• Main Authors: Standing, H R, Boag, K F, Hamstead, E C, Vaughan-Williams, S R, Hughes, M T, Peckham-Cooper, Abp
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Pain - diagnostic imaging; Abdominal Pain - etiology; Adolescent; Adult; Appendectomy; Appendicitis; Appendicitis - complications; Appendicitis - diagnostic imaging; Appendicitis - surgery; Cysts; Data collection; Demographics; Diagnosis, Differential; Female; Females; Gynecology; Histology; Hospitals; Humans; Innovation; Intestinal obstruction; Laparoscopy; Magnetic resonance imaging; Medical imaging; Middle Aged; Ovarian Cysts - complications; Ovarian Cysts - diagnostic imaging; Ovarian Cysts - surgery; Ovaries; Pain; Pathology; Patients; Pelvic Pain - diagnostic imaging; Pelvic Pain - etiology; Pelvis - diagnostic imaging; Radiation; Retrospective Studies; Ultrasonic imaging; Ultrasonography; Womens health; Young Adult
• ISSN: 0035-8843; 1478-7083; 1478-7083
• DOI: 10.1308/rcsann.2023.0098

Acute right iliac fossa (RIF) pain is a common presenting symptom in surgical patients, with a wide range of differentials, particularly in premenopausal females. This study explores ultrasound usage in the management of women aged 16-55 years presenting with RIF pain. A total of 1,082 patients who presented to a tertiary hospital over 12 months were included. Data were collected from patients' electronic records, including initial clinical impression, imaging, management, operative findings, histology and subsequent hospital attendances within 6 weeks and within 6 months. Following clinical assessment, 607 (56%) of patients underwent an ultrasound. Of these, 280 (25.9%) patients received no radiological imaging on initial presentation, and 252 (42%) had pathology identified on ultrasound. The most common finding was an ovarian cyst, closely followed by unexplained free pelvic fluid. Of the 607 patients scanned, 29 (4.8%) had an ultrasound diagnosis of appendicitis; 254 of 1,082 (23.5%) patients underwent operative management. Of the 254 patients who had surgery, 179 (70.5%) had preoperative imaging. Of the 29 (11.4%) cases where the intraoperative finding was gynaecological, 15 (51.7%) cases had not had any preoperative imaging. The negative appendicectomy rate was 21.3% (45/211). Of the 45 patients who had a histologically normal appendix, 22 (48.9%) had not had any previous imaging. Ultrasound had a specificity of 78% for diagnosing appendicitis. In patients who underwent operative management, a negative finding or finding not requiring surgical management was associated with no preoperative imaging. This supports the use of ultrasound scans as an adjunct in a multimodal approach to the assessment of women presenting with RIF pain.