الفهرس 
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Abstract
Acute appendicitis (AA) is the most common condition requiring emergency surgical intervention. Appendicular perforation is found in up to 20% of cases, and increases mortality from approximately 0.00002 to 3%, and morbidity from 3 to 47%. Thus, the appendix is frequently excised even in cases where even a low index of suspicion is held, leading to unnecessary surgery in up to 40% of patients.
The diagnosis of acute appendicitis is based purely on clinical history and examination combined with laboratory investigations such as elevated white cell count. Despite being a common problem, acute appendicitis remains a difficult diagnosis to establish, particularly among the young, the elderly and females of reproductive age, where a host of other genitourinary and gynaecological inflammatory conditions can present with signs and symptoms that are similar to those of acute appendicitis. A delay in performing an appendicectomy in order to improve its diagnostic accuracy increases the risk of appendicular perforation and sepsis, which in turn increases morbidity and mortality
AA can only be confirmed by histological examination of the resected appendix. Ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) can markedly assist in diagnosis in several cases; however, ultrasound is limited in obese patients, severe abdominal pain and retrocaecal and/or perforated appendicits. CT and MRI are relatively expensive and are not readily available in all centres. Additionally, in the presence of clinical suspicion, a negative radiological examination cannot exclude AA. Several scoring systems, such as the RIPASA scoring system, have been developed to assist in AA diagnosis
The Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score was developed in 2010 in Brunei and tested and replicated in Asian and Middle Eastern populations in Pakistan, China, India, Egypt and Saudi Arabia. RIPASA is a new diagnostic scoring system developed for the diagnosis of Acute Appendicitis and has been shown to have significantly higher sensitivity, specificity and diagnostic accuracy. RIPASA score is a simple qualitative scoring system based on 15 fixed clinical parameters more than Alvarado system as the later did not contain certain parameters such as age, gender, duration of symptoms prior to presentation.These parameters are shown to affect the sensitivity and specificity of Alvarado scoring system in the diagnosis of acute appendicitis
This prospective study included 193 patients with acute appendicitis attending General Surgery Department at Benha University Hospital after an approval from the Research and ethical Committee in Benha Faculty of Medicine.
All patients sign a written informed consent. Eligible patients included in this study were recruited from General Surgery Department, Benha University throughout the period from (November, 2021) to (June, 2023).
Patients of all age groups who received an emergency appendectomy and had histopathological analysis post-surgery to confirm a positive/negative appendectomy from (November,2021) to (June, 2023).
All included patients in this study were subjected to complete history intake, physical examination, routine laboratory and radiological investigations including: complete blood picture (CBC), Urine analysis, Pelvi-abdominal ultrasound, Plain X-ray erect chest, abdomen and pelvis and CT abdomen and pelvis if needed.
All items of RIPASA score was documented which are Gender, Aging Symptoms like: Right iliac fossa pain, Migration of right lower quadrant pain, Anorexia, Nausea and vomiting, Duration of symptoms (48hrs) and Signs like : Right iliac fossa tenderness, Right iliac fossa guarding, Rebound tenderness, Rovsing’s sign, Fever Laboratory tests: Raised white blood cells, Negative urine analysis.
The main results of our study:
the mean age was 34.2 ± 3.2. Among them 74.1% aged <39.9 years while 25.9% aged >40 years. 46.7% were male while 53.3% were female. 3.6% were grade 1, 45% grade 2, 44% grade 3 while 7.4% grade 4. 11.4% had DM, 13% had Hypertension and 5% had IHD.
45% had Rt. iliac fossa pain, 44% had Anorexia, 70% had Nausea and vomiting, 25% had Fever, 100% had Rt. iliac fossa tenderness, 55% had Guarding while 87% had Rebound tenderness. 45% had Elevated WBCs, 55% had Negative urine analysis and 87% had Rovsing Sign.
mean RIPASA Score was 10.2 ± 2.3. 2.6% cases had score 7, 12% had score 8, 22.8% had score 9, 19.2% had score 10, 16% had score 11, 16% had score 12, 8.8% had score 13 while 3.1% had score 14. The mean RIPASA Score was 10.2 ± 2.3.
90.15% were Confirmed Histology for AA. 9.85% were Negative Histology for Acute Appendicitis
true Positive was 170 cases. True Negative was 13.
there were strong significant correlations between RIPASA scores and age, sex, Right iliac fossa pain, Anorexia, Nausea and vomiting and Rovsing’s sign
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