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Acute appendicitis in children: value of sonography in detecting perforation
S P Quillin1, M J Siegel, C M Coffin
1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
Insights
Sonography can help diagnose perforating appendicitis in children. Key indicators include the absence of an echogenic submucosal layer and the presence of loculated fluid collections, aiding in differentiating perforation.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
- Surgical Diagnostics
Background:
- Appendicitis is a common surgical emergency in children.
- Distinguishing between nonperforating and perforating appendicitis is crucial for appropriate management.
- Sonography is a widely used imaging modality in pediatric patients.
Purpose of the Study:
- To identify sonographic features indicative of perforating appendicitis in children.
- To establish diagnostic criteria for perforating appendicitis using ultrasound.
- To improve the accuracy of sonographic diagnosis in pediatric appendicitis.
Main Methods:
- Retrospective review of 71 pediatric patients with confirmed appendicitis.
- Analysis of sonographic findings including appendix visibility, echogenic submucosa, periappendiceal fluid, and appendicoliths.
- Correlation of sonographic findings with surgical and pathological results.
Main Results:
- Perforating appendicitis was present in 26 of 71 children.
- A visible appendix on sonography was less common in perforating appendicitis (38%) compared to nonperforating (100%).
- Absence of the echogenic submucosal layer and presence of loculated periappendiceal/pelvic fluid were significantly associated with perforation.
Conclusions:
- Sonography is a valuable tool for diagnosing perforating appendicitis in children.
- The absence of an echogenic submucosal layer and the presence of loculated fluid collections are the most reliable sonographic predictors of perforation.
- These findings can guide surgical decisions and improve patient outcomes.
Objective:
We determined the sonographic features of perforating appendicitis in children in order to determine the best criteria for establishing the diagnosis.
Materials And Methods:
Sonograms of the right lower quadrants of 71 children with proved appendicitis were reviewed to determine the value of sonography in distinguishing between nonperforating and perforating appendicitis. The sonographic signs evaluated included the presence or absence of an appendix, an echogenic submucosal layer, increased periappendiceal echogenicity, free or loculated periappendiceal or pelvic fluid collections, and appendicoliths. The sonographic findings were correlated with the surgical and pathologic findings.
Results:
Forty-five patients had nonperforating appendicitis, and 26 had perforating appendicitis. A sonographically visible appendix was present in all patients with nonperforating appendicitis and in 10 (38%) of 26 patients with perforation. An echogenic submucosa was noted in 27 (60%) of 45 patients with uncomplicated appendicitis but in only three (30%) of 10 patients with a visible appendix and perforating appendicitis (p < .05). In 19 of 26 patients with perforating appendicitis, sonography showed loculated periappendiceal or pelvic fluid collections; no patient with nonperforating appendicitis had a loculated fluid collection (p < .05). No statistically significant association was found between the presence or absence of perforation and free pelvic fluid, prominent periappendiceal fat, or an appendicolith.
Conclusion:
Our results indicate that sonography can be helpful in the diagnosis of perforating appendicitis. The best predictors of perforation are absence of the echogenic submucosal layer and the presence of a loculated fluid collection.