Abstract
Amaç:
Akut apandisit (AA) ön tanısıyla acile başvuran hastaların çoğuna ayakta düz
batın grafisi (ADBG) çekilmektedir; fakat ADBG’nin AA tanısına katkısı
günümüzde sorgulanmaktadır. Çalışmamızın amacı tartışmalı olan bu konuyu
aydınlatmak için ADBG’nin AA tanısındaki önemini irdelemektir.
Gereç ve Yöntemler:
Ordu Üniversitesi Eğitim ve Araştırma Hastanesi Genel Cerrahi Bölümünde 2014 ve
2017 yılları arasında AA ön tanısıyla ameliyat edilen hastaların preoperatif
çekilen ADBG bulguları ile patoloji sonuçları kıyaslandı. ADBG bulguları ile AA
tanısı arasındaki ilişki irdelendi.
Bulgular:
AA şüphesi nedeniyle ameliyat edilen 180 hastanın 140 (%77,8)’ına ADBG çekildi.
ADBG de bulguya rastlanan 105 hastanın 90’nın (%85,7) da AA varken 15’ inde
(%14,3) yoktu. ADBG’de herhangi bir bulguya rastlanmayan 35 hastanın ise 25’
inde (%71,4) AA varken 10’ unda (%28,6) yoktu. ADBG bulgusu olan ve olmayan
hastalar da AA tanısı koyma açısından istatistiksel olarak bir fark
yoktu(p=0,098). ADBG çekimi yapılan hastaların 115’ inde (%82,1) AA varken 25’
inde (%17,9) yoktu. ADBG çekimi yapılmayan hastaların ise 27’ sinde (%67,5) AA
varken 13’ ünde (%32,5) yoktu. ADBG çekimi yapılıp yapılmaması AA tanısına etki
etmemektedir (p=0,07).
Sonuç:
ADBG, AA tanısını koymada nadiren yardımcı olur. AA düşünülen her hastaya ADBG
çekmektense hekimin aklında ön tanı olarak AA dışında başka bir akut batın
nedeni daha varsa ucuz, erişilebilir ve kolay yorumlanabilir olması nedeniyle
ADBG çekilebilir.
Keywords
References
- 1. Menteş Ö, Eryılmaz M, Yiğit T, ve ark. 60 yaş üstü apandektomili olgularımızın retrospektif analizi. JAEM 2008; 7: 36-41.
- 2. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910–25.
- 3.Humes, DJ, Simpson J. Acute appendicitis. BMJ. 2006; 333: 530-34.
- 4. Brooks DW, Killen DA. Roentgenographic findings in acute appendicitis. Surgery 1965; 57: 377-384.
- 5. Reynolds SL. Missed appendicitis in a pediatric emergency department. Pediatr Emerg Care. 1993 Feb;9(1):1-3.
- 6. Aygun A, Katipoglu B, Imamoglu M. et al. Diagnostic value of plasma pentraxin-3 in acute appendicitis. J Invest Surg 2017;11: 1-6.
- 7. Parks NA, Schroeppel TJ. Update on imaging for acute appendicitis. Surg Clin North Am 2011; 91:141-54.
- 8. Eriksson S, Granstrom L, Carlstrom A. The diagnostic value of repetitive preoperative analysis of C-reactive protein and total leukocyte count in patients with suspected acute appendicitis. Scand J Gastroenterol 1994; 29:1145-49.
- 9. Thompson MM, Underwood MJ, Dookeran KA, Lloyd DM, Bell PR. Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis. Br J Surg. 1992 ; 79: 822-24.
- 10. Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 2002; 137: 799-804
- 11. Hastings RS, Powers RD. Abdominal pain in the ED: a 35 year retrospective. Am J Emerg Med 2011; 29: 711-16.
- 12. Rodrigues G, Kanniayan L, Gopashetty M, Rao S, Shenoy R. Plain X-ray in Actue Appendicits. The Internet Journal of Radiology 2003; 3:1-4.
- 13. Ellis H, Nathanson LK. Appendix and appendectomy. In: Zinner MJ, Schwartz ST, Ellis H (eds). Maingot's abdominal operations, 10th ed, Appleton and Lange, New York 1997: 1191-1227.
- 14. MacKersie AB, Lane MJ, Gerhardt RT, et al. Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series. Radiology 2005; 237: 114-22.
- 15. Oncel M, Degirmenci B, Demirhan N, Hakyemez B, Altuntas YE, Aydinli M. Is the use of plain abdominal radiographs (PAR) a necessity for all patients with suspected acute appendicitis in emergency services?. Curr Surg 2003; 60: 296-300.
- 16. Ahn SH, Mayo-Smith WW, Murphy BL, Reinert SE, Cronan JJ. Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation. Radiology 2002; 225:159-64.
- 17. Jenkins D, Lee P. Radiology in acute appendicitis. J R Coll Surg Edinb 1970; 15: 34–37.
- 18. Shimkin PM. Radiology of acute appendicitis. Am J Roentgenol 1978; 130:1001-4.
- 19. Turkyılmaz Z, Sonmez K, Konus O, et al. Diagnostic value of plain abdominal radiographics in acute appendicitis in children. East Afr Med J 2004; 81: 104-7.
- 20. Phillpott JW, Swischuk LE, John SD. Appendicitis in the era of ultrasound: Are plain radiographs stil useful? Emerg Radiol 1997; 4: 68-71.
- 21.Joffe N. Radiology of acute appendicitis and its complications. CRC Crit Rev Clin Radiol Nucl Med. 1975;7:97-160
- 22. Lee PWR. The plain film in the acute abdomen: a surgeon’s evaluation. Br J Surg. 1976 ;63:763-66.
- 23. Makanjuola D, Al Qasabi Q, Malabarey T. A comparative ultrasound and plain abdominal x-ray: evaluation of non-classical clinical cases of appendicitis. Ann Saudi Med. 1993; 13: 41-46.
- 24. Old JL, Dusing RW, Yap W, Dirks J. Imaging for suspected appendicitis. Am Fam Physician 2005; 71: 71-78.
- 25. Boleslawski E, Panis Y, Benoist S, Denet C, Mariani P, Valleur P. Plain abdominal radiography as a routine procedure for acute abdominal pain of the right lower quadrant: prospective evaluation. World J Surg. 1999; 23: 262-64.
Abstract
Aim:
Most of the patients presenting to the emergency department with an preliminary
diagnosis of acute appendicitis (AA) are undergoing standing plain abdominal
radiography (SPAR), but SPAR's contribution to the diagnosis of AA is being
questioned today. The aim of our study is to evaluate the importance of SPAR in
the diagnosis of AA to elucidate this controversial issue.
Material and Methods:
We evaluated preoperative SPAR findings and pathology results of patients who were
operated with the diagnosis of AA between 2014 and 2017 at General Surgery
Department of Ordu University Training and Research Hospital. The relationship
between the presence/absence of the SPAR findings and the diagnosis of AA were
analyzed.
Results: 140
(77.8%) of 180 patients who were operated for suspicion of AA underwent SPAR. Of
the 105 patients with SPAR findings, 90 (85.7%) had AA and 15 (14.3%) were no. No
findings were found in the 35 of patients who underwent SPAR, 25 (71.4%) had AA
and 10 (28.6%) did not. There was no statistically significant difference in
the diagnosis of AA in patients with and without SPAR findings (p = 0.098). Of
the 140 patients undergoing SPAR, 115 (82.1%) had AA, and 25 (17.9%) were no.
Of the 40 patients without SPAR, 27 (67.5%) had AA and 13 (32.5%) did not.
Whether or not SPAR was performed did not affect the diagnosis of AA (p =
0.07).
Conclusion: SPAR
rarely helps in diagnosis of AA. SPAR should not be routinely taken to every
patient considered AA. If there is another cause of acute abdomen other than AA
as a pre-diagnosis in the physician's mind, SPAR may be taken because it is
cheap, accessible and easily interpretable.
References
- 1. Menteş Ö, Eryılmaz M, Yiğit T, ve ark. 60 yaş üstü apandektomili olgularımızın retrospektif analizi. JAEM 2008; 7: 36-41.
- 2. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910–25.
- 3.Humes, DJ, Simpson J. Acute appendicitis. BMJ. 2006; 333: 530-34.
- 4. Brooks DW, Killen DA. Roentgenographic findings in acute appendicitis. Surgery 1965; 57: 377-384.
- 5. Reynolds SL. Missed appendicitis in a pediatric emergency department. Pediatr Emerg Care. 1993 Feb;9(1):1-3.
- 6. Aygun A, Katipoglu B, Imamoglu M. et al. Diagnostic value of plasma pentraxin-3 in acute appendicitis. J Invest Surg 2017;11: 1-6.
- 7. Parks NA, Schroeppel TJ. Update on imaging for acute appendicitis. Surg Clin North Am 2011; 91:141-54.
- 8. Eriksson S, Granstrom L, Carlstrom A. The diagnostic value of repetitive preoperative analysis of C-reactive protein and total leukocyte count in patients with suspected acute appendicitis. Scand J Gastroenterol 1994; 29:1145-49.
- 9. Thompson MM, Underwood MJ, Dookeran KA, Lloyd DM, Bell PR. Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis. Br J Surg. 1992 ; 79: 822-24.
- 10. Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 2002; 137: 799-804
- 11. Hastings RS, Powers RD. Abdominal pain in the ED: a 35 year retrospective. Am J Emerg Med 2011; 29: 711-16.
- 12. Rodrigues G, Kanniayan L, Gopashetty M, Rao S, Shenoy R. Plain X-ray in Actue Appendicits. The Internet Journal of Radiology 2003; 3:1-4.
- 13. Ellis H, Nathanson LK. Appendix and appendectomy. In: Zinner MJ, Schwartz ST, Ellis H (eds). Maingot's abdominal operations, 10th ed, Appleton and Lange, New York 1997: 1191-1227.
- 14. MacKersie AB, Lane MJ, Gerhardt RT, et al. Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series. Radiology 2005; 237: 114-22.
- 15. Oncel M, Degirmenci B, Demirhan N, Hakyemez B, Altuntas YE, Aydinli M. Is the use of plain abdominal radiographs (PAR) a necessity for all patients with suspected acute appendicitis in emergency services?. Curr Surg 2003; 60: 296-300.
- 16. Ahn SH, Mayo-Smith WW, Murphy BL, Reinert SE, Cronan JJ. Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation. Radiology 2002; 225:159-64.
- 17. Jenkins D, Lee P. Radiology in acute appendicitis. J R Coll Surg Edinb 1970; 15: 34–37.
- 18. Shimkin PM. Radiology of acute appendicitis. Am J Roentgenol 1978; 130:1001-4.
- 19. Turkyılmaz Z, Sonmez K, Konus O, et al. Diagnostic value of plain abdominal radiographics in acute appendicitis in children. East Afr Med J 2004; 81: 104-7.
- 20. Phillpott JW, Swischuk LE, John SD. Appendicitis in the era of ultrasound: Are plain radiographs stil useful? Emerg Radiol 1997; 4: 68-71.
- 21.Joffe N. Radiology of acute appendicitis and its complications. CRC Crit Rev Clin Radiol Nucl Med. 1975;7:97-160
- 22. Lee PWR. The plain film in the acute abdomen: a surgeon’s evaluation. Br J Surg. 1976 ;63:763-66.
- 23. Makanjuola D, Al Qasabi Q, Malabarey T. A comparative ultrasound and plain abdominal x-ray: evaluation of non-classical clinical cases of appendicitis. Ann Saudi Med. 1993; 13: 41-46.
- 24. Old JL, Dusing RW, Yap W, Dirks J. Imaging for suspected appendicitis. Am Fam Physician 2005; 71: 71-78.
- 25. Boleslawski E, Panis Y, Benoist S, Denet C, Mariani P, Valleur P. Plain abdominal radiography as a routine procedure for acute abdominal pain of the right lower quadrant: prospective evaluation. World J Surg. 1999; 23: 262-64.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original article |
| Authors | |
| Publication Date | March 31, 2019 |
| Published in Issue | Year 2019 Volume: 11 Issue: 1 |
e-ISSN: 2548-0251
The content of this site is intended for health care professionals. All the published articles are distributed under the terms of
Creative Commons Attribution Licence,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.