[Diagnostic significance of clinical symptoms versus ultrasonography in appendicitis. A prospective study]

The aim of the presented study was to find what importance ultrasonography has in the diagnosis of acute appendicitis compared to clinical findings and on the surgeon's decision regarding to laparotomy. 111 patients entering the emergency station with suspected appendicitis were evaluated in a prospective clinical study. Surgeon and radiologist had to commit themselves to the diagnosis, afterwards signs were discussed. Clinical accuracy over all was 89%. Pain migration and peritonitis signs corresponded significantly with appendicitis (p less than 0.0001). The appendix was well seen in sonographic examination in 32% (accuracy 80%), in 27% was doubtful (accuracy 70%), and in 41% the appendix could not be demonstrated. Diameter of a normal appendix was 8 mm compared to 12 mm for an inflamed appendix (p less than 0.05). Rates negative laparotomies decreased from 16% to 12.7%. The surgeon was not influenced by sonography in 75%. In 12% ultrasonography decided for laparotomy and in 4.5% sonography prevented operation. We conclude from our results, that sonography reduces the negative laparotomy rate. Ultrasonography is especially useful in doubtful clinical pictures. Clinical findings and experience remain of major importance in appendicitis-diagnosis.