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The sensitivity of plain films for detecting perforation in children with appendicitis
J F Johnson1, W F Coughlin, P Stark
1Department of Radiology and Pediatries Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Plain film X-rays can accurately detect appendicitis perforation in children. Specific signs like extraluminal gas and bowel obstruction suggest rupture, aiding diagnosis in pediatric patients.
Area of Science:
- Radiology
- Pediatric Surgery
- Gastroenterology
Background:
- Appendicitis is a common surgical emergency in children.
- Accurate diagnosis of appendicitis perforation is crucial for timely intervention and improved outcomes.
- Plain film radiography remains a widely accessible imaging modality.
Purpose of the Study:
- To evaluate the diagnostic accuracy of plain abdominal films in identifying appendicitis perforation in pediatric patients.
- To determine specific radiographic findings indicative of perforation.
Main Methods:
- Retrospective review of plain films from 37 pediatric patients (under 18) with surgically confirmed appendicitis.
- Analysis of six defined radiographic findings suggestive of perforation: small bowel obstruction, extraluminal gas, right lower quadrant mass, colon cut-off sign, fecalith, and obliterated fat planes.
- Correlation of findings with surgical and pathological results.
Main Results:
- Plain films demonstrated 80% sensitivity and 94% specificity for detecting appendicitis perforation.
- Specific findings like extraluminal gas (triangular accumulation in the right flank) and acute small bowel obstruction were key indicators.
- A single false positive occurred in a patient with a fecalith.
Conclusions:
- Plain film radiography is a valuable tool for diagnosing appendicitis perforation in children.
- The presence of specific radiographic signs significantly increases the likelihood of perforation.
- Radiologists can effectively differentiate between intraluminal and extraluminal gas on supine or prone films.
Abstract:
The plain films of 37 patients under age 18 with surgically and pathologically proven non perforated (16/37) and ruptured (21/37) appendicitis were reviewed in order to determine the ability of the plain film to specify perforation. Perforation was suggested when one or more of the following six findings were clearly defined: 1. Acute small bowel obstruction. 2. Extraluminal gas. 3. Mass in the right lower quadrant. 4. Colon cut-off sign at the hepatic flexure. 5. Fecalith. 6. Obliteration of the pelvic fat planes. This approach resulted in a sensitivity of 80% and a specificity of 94%, with the only false positive for perforation occurring in a patient with a fecalith. In five patients, extraluminal gas produced a triangular accumulation in the right flank which could be distinguished from intraluminal bowel gas on the supine or prone film.