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Pitfalls in the use of barium enema in early appendicitis in children
Insights
Barium enema aids appendicitis diagnosis in children, especially when positive. However, a negative result cannot rule out appendicitis, particularly with concerning abdominal signs.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
Background:
- Appendicitis is the most frequent intra-abdominal surgical diagnosis in children.
- Barium enema is increasingly used for diagnosing difficult appendicitis cases.
Purpose of the Study:
- To evaluate the effectiveness and limitations of barium enema in diagnosing acute appendicitis in pediatric patients.
- To identify potential problems associated with using barium enema as a diagnostic tool.
Main Methods:
- Retrospective review of 202 barium enema procedures in children with suspected appendicitis.
- Correlation of barium enema findings with surgical outcomes.
- Analysis of false negatives and equivocal results.
Main Results:
- Of 66 surgically confirmed cases, 32 had positive barium enemas, with 31 correctly identifying appendicitis.
- Three false negatives occurred, two in children with early perforations.
- Equivocal results highlighted challenges in interpreting normal findings in non-appendicitis cases.
Conclusions:
- Barium enema is a valuable adjunct for diagnosing pediatric appendicitis, particularly when positive.
- A negative barium enema should not delay surgery in children presenting with right lower quadrant peritoneal signs.
Abstract:
Appendicitis remains the most common intraabdominal indication for surgery in children. Recently, barium enema has been helpful in increasing the accuracy of diagnosis in difficult cases. Experience with 202 barium enemas in children with abdominal pain entertaining the diagnosis of acute appendicitis revealed some of the problems encountered in using this procedure as a diagnostic tool. Of the 66 children who underwent surgery, there were 32 children who were felt to have a positive barium enema and 31 of these turned out to have acute appendicitis. In the group that had negative barium enemas, there were 3 false negatives and 2 of these children had early perforations by the time of their surgery. The third group were equivocal barium enemas and they pointed out the difficulty in obtaining a normal barium enema in a child who does not have appendicitis. It was felt that the use of barium enema as an adjunct was helpful especially if it were positive, but a negative barium enema could not be relied upon to delay surgery in the child with right lower quadrant peritoneal signs.