Pediatric acute appendicitis: Searching the diagnosis in portal vein

Acute appendicitis is the most common reason for emergency abdominal surgery in the pediatric population. Ultrasound (US) is a widely used modality to diagnose acute appendicitis. The aim of this study was to evaluate the effectiveness of portal vein diameter and flow velocity in acute appendicitis diagnosis.

Portal vein diameter and flow velocity were measured in children who were referred to radiology with a clinical diagnosis of acute appendicitis. The largest appendix diameter and leukocyte count of the patients were recorded. A control group was created which consisted of healthy children, and their portal vein diameter and flow velocities were also measured.

The median age of the population was 10 years (range, 3-17 years). Mean portal vein diameter was 7.53 ± 1.55 mm in the control group, 7.92 ± 1.88 mm in the other diagnosis group, and 8.76 ± 1.91 mm in the acute appendicitis group. Mean portal vein diameter was significantly higher in the acute appendicitis group (p = 0.001). Median portal vein flow velocity was 17 cm/s (10-29 cm/s) in the control group, 18.3 cm/s (8-27 cm/s) in the other diagnosis group, and 20.5 cm/s in the acute appendicitis group. Median portal vein flow velocity was significantly higher in the acute appendicitis group (p = 0.00).

Detecting an increase in portal vein diameter and/or flow velocity in equivocal cases may support other clinical signs associated with acute appendicitis. Portal vein diameter and flow velocity can serve as additional diagnostic markers in acute appendicitis cases.