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Improved sonographic visualization of the appendix with a saline enema in children with suspected appendicitis
1Department of Radiology, Eulji University School of Medicine, Taejon, Korea.
Insights
Saline enema sonography helps visualize the appendix in children when initial scans fail. This technique successfully identified the appendix in all cases, aiding in appendicitis diagnosis.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
Background:
- Graded compression sonography is standard for diagnosing appendicitis in children.
- The appendix is not visualized in a subset of patients, posing a diagnostic challenge.
Purpose of the Study:
- To evaluate the efficacy of abdominal sonography with a saline enema in visualizing the appendix in children with suspected appendicitis when it's not seen on initial sonography.
Main Methods:
- 120 children with suspected appendicitis underwent high-frequency compression sonography.
- In 27 cases where the appendix was not visualized, 12 underwent abdominal sonography after a saline enema.
Main Results:
- Abdominal sonography after saline enema visualized the appendix in all 12 children.
- The appendix was located in the pelvis, posterior to the cecum, or posterior/anterior to the ileum.
- A saline-filled colon or terminal ileum provided an acoustic window for visualization.
Conclusions:
- Abdominal sonography with a saline enema is a valuable adjunct for visualizing the appendix in children when initial sonography is inconclusive.
- This technique aids in the diagnosis of appendicitis in challenging pediatric cases.
Objective:
To determine whether abdominal sonography after a saline enema can identify the appendix that is not visualized at graded compression sonography in children with suspected appendicitis.
Methods:
High-frequency compression sonography was prospectively performed in 120 consecutive children with suspected appendicitis; the appendix was not identified in 27 of these patients. Among the 27 patients with a nonvisualized appendix, abdominal sonography after a saline enema was performed in 12 to identify the appendix.
Results:
Abdominal sonography after the saline enema revealed the appendix in all 12 children in whom the appendix was not visualized at graded compression sonography. A normal appendix was found in 11 children, and acute appendicitis confined to the appendiceal tip was found in 1. The appendix was located in the pelvis (n = 5), posterior to the cecum (n = 4), posterior to the ileum (n = 2), and anterior to the ileum (n = 1). The appendix could be identified by using a window of the saline-filled sigmoid colon (n = 5), saline-filled cecum (n = 4), and saline-filled terminal ileum (n = 2).
Conclusions:
Abdominal sonography after a saline enema is a helpful technique for depiction of the appendix that is not visible at graded compression sonography in children with suspected appendicitis. Key words: appendix, sonography; appendicitis; children, gastrointestinal tract.