ABSTRACT
:
OBJECTIVE. Acute
appendicitis is the most common condition requiring emergency surgery in
children. Differentiation of perforated from nonperforated appendicitis is
important because perforated appendicitis may initially be managed
conservatively whereas nonperforated appendicitis requires immediate surgical
intervention. CT has been proved effective in identifying appendiceal
perforation. The purpose of this study was to determine whether perforated and
nonperforated appendicitis in children can be similarly differentiated with
ultrasound.
MATERIALS AND METHODS. This
retrospective study included 161 consecutively registered children from two
centers who had acute appendicitis and had undergone ultra-sound and
appendectomy. Ultrasound images were reviewed for appendiceal size, appearance
of the appendiceal wall, changes in periappendiceal fat, and presence of free
fluid, abscess, or appendicolith. The surgical report served as the reference
standard for determining whether perforation was present. The specificity and sensitivity
of each ultrasound finding were determined, and binary models were generated.
RESULTS. The
patients included were 94 boys and 67 girls (age range, 1–20 years; mean, 11 ±
4.4 [SD] years) The appendiceal perforation rate was significantly higher in
children younger than 8 years (62.5%) compared with older children (29.5%).
Sonographic findings associated with perforation included abscess (sensitivity,
36.2%; specificity, 99%), loss of the echogenic submucosal layer of the
appendix in a child younger than 8 years (sensitivity, 100%; specificity,
72.7%), and presence of an appendicolith in a child younger than 8 years
(sensitivity, 68.4%; specificity, 91.7%).
CONCLUSION.
Ultrasound is effective for differentiation of perforated from nonperforated
appendicitis in children.
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