Transvaginal Ultrasound in Surgical Treatment: An Observational Cohort Study on the Impact of Transvaginal Ultrasound in Appendicitis Management and Treatment Outcomes

Abstract Background: Transvaginal ultrasound (TVUS) is widely used to evaluate right iliac fossa (RIF) pain in women, yet its diagnostic utility in appendicitis remains unclear. This study assessed the impact of TVUS on surgical decision-making and evaluated patient selection consistency between General Surgery and Gynaecology pathways. Methods: A retrospective cohort of 1,445 women aged ≥16 who underwent urgent TVUS at a single institution (2018–2022) was analysed. Follow-up or incomplete reports were excluded. TVUS findings, blood investigations, and histology results were reviewed. Positive TVUS findings were defined as free fluid or appendicitis (excluding gynaecological pathology). Statistical analyses examined the relationship between TVUS results, surgical intervention, and histological outcomes. Results: Of the cohort, 825 patients were admitted under General Surgery and 620 under Gynaecology. Positive TVUS findings were more frequent in the Gynaecology cohort (48.0% vs. 34.5%, P < 0.00001). However, TVUS positivity did not significantly influence surgical decisions (OR 1.01, 95% CI 0.69–1.46, P = 0.97) or confirm appendicitis histologically (OR 0.50, 95% CI 0.20–1.20, P = 0.130). By contrast, abnormal blood results strongly predicted appendicitis (OR 2.96, 95% CI 1.07–9.09, P = 0.043). Conclusion: TVUS has limited utility in the General Surgery pathway and should not be routinely performed in patients with abnormal blood results. Patients with normal bloods, unlikely to have appendicitis, should instead be referred to Gynaecology, where TVUS better identifies gynaecological pathology. Diagnostic strategies should prioritise blood tests and alternative imaging to enhance patient outcomes.