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Sonography of acute appendicitis in childhood: perforation versus nonperforation
C K Hayden1, J Kuchelmeister, T S Lipscomb
1Department of Pediatric Radiology, Cook-Fort Worth Children's Medical Center, TX 76104.
Insights
High-resolution ultrasound effectively identifies nonperforated appendicitis in children. However, diagnosing perforated appendicitis using sonography is challenging due to appendix decompression and lack of abscess formation.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
- Emergency Medicine
Background:
- Appendicitis is a common surgical emergency in children.
- Accurate diagnosis is crucial to prevent complications.
- Sonography is a primary imaging modality for suspected appendicitis.
Purpose of the Study:
- To evaluate sonographic findings in children with suspected appendicitis.
- To compare sonographic features of nonperforated versus perforated appendicitis.
- To assess the diagnostic utility of specific sonographic signs.
Main Methods:
- Retrospective review of 133 children undergoing sonography for suspected appendicitis.
- Correlation of sonographic findings with surgical and pathological outcomes.
- Analysis of appendix visualization, localized/pelvic fluid, and adenopathy.
Main Results:
- High-resolution, real-time sonography with graded compression showed high sensitivity for nonperforated appendicitis.
- Perforated appendicitis was more challenging to diagnose sonographically.
- Difficulties in diagnosing perforated appendicitis stem from appendix decompression and poor abscess walling.
Conclusions:
- Sonography is highly sensitive for diagnosing acute nonperforated appendicitis in children.
- Diagnosing perforated appendicitis sonographically presents challenges.
- Further refinement of sonographic techniques may be needed for perforated appendicitis.
Abstract:
We evaluated the sonographic findings in 133 consecutive children referred for suspected appendicitis. Fifty-eight of these patients (44%) ultimately underwent surgery, with 54 of these proved to have acute appendicitis. Thirty-one (58%) of the 54 had nonperforated appendicitis, and 23 (43%) had evidence of perforation. Previously described sonographic findings that have been employed in the diagnosis of appendicitis were evaluated, with the presence or absence of these findings being compared in patients with non-perforated and perforated appendicitis. In those patients who did not undergo surgery, the following findings were documented and compared to the findings in patients with proved appendicitis: (1) an identifiable appendix and its sonographic characteristics, (2) fluid localized to the right peritoneal reflection or periappendiceal region, or both, (3) free pelvic fluid, and (4) right lower quadrant adenopathy. Our results suggest that high-resolution, real-time sonography, using graded compression, is very sensitive in the identification of acute nonperforated appendicitis. Perforated appendicitis, however, can be a more difficult diagnosis because the appendix frequently decompresses with perforation and yet may not "wall off" or form a well-defined abscess. As a result, the appendix can be very difficult to identify.