Abstract
Objective: Acute appendicitis is the most common reason for emergency abdominal surgery in pediatric population. Ultrasonography (US) is a widely used modality to diagnose acute appendicitis. Despite its success in diagnosing acute appendicitis, US have been reported to have a poor diagnostic accuracy to detect perforated appendicitis. We have frequently encountered lymph nodes around transvers colon in pediatric perforated appendicitis cases. We mainly aim to evaluate the accuracy of paracolic lymph node presence as a new diagnostic marker for perforated appendicitis.
Materials and Methods: We have evaluated the US reports and/or images of the patients referred to radiology department with a clinical suspicion of acute appendicitis. Paracolic lymph node presence and sonographic findings indicating perforated appendicitis were recorded. Patients were divided into three subgroups according to their final diagnosis: Acute appendicitis, perforated appendicitis, others.
Results: Mean age of the population was 14.9±2.3 years. There were 300 acute appendicitis cases, 71 perforated appendicitis cases, and 92 other diagnosis cases (4 lymphoid hyperplasia, 88 normal appendix). Rates of lymph node presence in paracolic area were 41/300 (13.6%) in acute appendicitis subgroup, 58/71 (81.6%) in perforated appendicitis subgroup, and 4/92 (4.34%) in other diagnosis subgroup. A longest diameter of a paracolic lymph node > 8.5 mm seemed to be a good predictor for perforated appendicitis diagnosis (sensitivity 85%, specificity 77%).
Conclusion: we showed a statistically significant association between paracolic lymph node presence and perforated appendicitis. This sign can serve to confirm perforated appendicitis diagnosis over simple appendicitis.
References
- 1. Carpenter JL, Orth RC, Zhang W, Lopez ME, Mangona KL, Guillerman RP. Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study. Radiology. 2017;282(3):835-41. 2. Sivit CJ. Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts. Pediatric radiology. 2004;34(6):447-53. 3. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American journal of epidemiology. 1990;132(5):910-25. 4. Tulin-Silver S, Babb J, Pinkney L, Strubel N, Lala S, Milla SS, et al. The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity. Pediatric radiology. 2015;45(6):820-30. 5. Linam LE, Munden M. Sonography as the first line of evaluation in children with suspected acute appendicitis. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2012;31(8):1153-7. 6. Aydin S, Tek C, Ergun E, Kazci O, Kosar PN. Acute Appendicitis or Lymphoid Hyperplasia: How to Distinguish More Safely? Can Assoc Radiol J. 2019;70(4):354-60. 7. Leeuwenburgh MM, Wiezer MJ, Wiarda BM, Bouma WH, Phoa SS, Stockmann HB, et al. Accuracy of MRI compared with ultrasound imaging and selective use of CT to discriminate simple from perforated appendicitis. The British journal of surgery. 2014;101(1):e147-55. 8. Tseng P, Berdahl C, Kearl YL, Behar S, Cooper J, Dollbaum R, et al. Does Right Lower Quadrant Abdominal Ultrasound Accurately Identify Perforation in Pediatric Acute Appendicitis? The Journal of emergency medicine. 2016;50(4):638-42. 9. Narsule CK, Kahle EJ, Kim DS, Anderson AC, Luks FI. Effect of delay in presentation on rate of perforation in children with appendicitis. The American journal of emergency medicine. 2011;29(8):890-3. 10. Lee SL, Stark R, Yaghoubian A, Shekherdimian S, Kaji A. Does age affect the outcomes and management of pediatric appendicitis? Journal of pediatric surgery. 2011;46(12):2342-5. 11. Gonzalez DO, Lawrence AE, Cooper JN, Sola R, Jr., Garvey E, Weber BC, et al. Can ultrasound reliably identify complicated appendicitis in children? The Journal of surgical research. 2018;229:76-81. 12. Blumfield E, Nayak G, Srinivasan R, Muranaka MT, Blitman NM, Blumfield A, et al. Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients. AJR American journal of roentgenology. 2013;200(5):957-62. 13. Azzali G. Three-dimensional and ultrastructural aspects of the lymphatic vascularization of the vermiform appendix. Journal of submicroscopic cytology and pathology. 1998;30(4):545-53. 14. Broker ME, van Lieshout EM, van der Elst M, Stassen LP, Schepers T. Discriminating between simple and perforated appendicitis. The Journal of surgical research. 2012;176(1):79-83.
Abstract
Amaç: Çalışmada perikolonik lenf nodu varlığının perfore apandisit için yeni bir tanı işareti olarak kullanılıp kullanılamayacağını değerlendirmek amaçlandı.
Gereç ve Yöntem: Bu retrospektif çalışmaya akut apandisit şüphesi ile pediatrik radyoloji bölümüne sevk edilen toplam 463 hasta dahil edildi. Perfore apandisit ile ilişkili perikolonik lenf nodu varlığı ve sonografik bulgular kaydedildi. Hastalar kesin tanılarına göre üç alt gruba ayrıldı: akut apandisit, perfore apandisit ve diğerleri.
Bulgular: 300 akut apandisit vakası, 71 perfore apandisit vakası ve “diğer tanı” grubunda 92 hasta vardı. Her grupta perikolonik lenf nodu varlığı sıklığı şu şekilde idi: Akut apandisit alt grubunda 41/300 (% 13,6), delikli apandisit alt grubunda 58/71 (% 81,6) ve diğer tanıda 4/92 (% 4,34) hasta bulunmakta idi. Perfore apandisit tanısı için en az 8,5 mm çapında bir perikolonik lenf nodu varlığı iyi bir yordayıcı olarak belirlendi (duyarlılık% 85, özgüllük% 77).
Sonuç: Perikolonik lenf nodu varlığı ile perfore apandisit arasında istatistiksel olarak anlamlı bir ilişki olduğunu gösterdik. Bu işaret, perfore apandisit olduğundan şüphelenilen vakalarda tanıyı doğrulamaya yardımcı olabilir.
Keywords
References
- 1. Carpenter JL, Orth RC, Zhang W, Lopez ME, Mangona KL, Guillerman RP. Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study. Radiology. 2017;282(3):835-41. 2. Sivit CJ. Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts. Pediatric radiology. 2004;34(6):447-53. 3. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American journal of epidemiology. 1990;132(5):910-25. 4. Tulin-Silver S, Babb J, Pinkney L, Strubel N, Lala S, Milla SS, et al. The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity. Pediatric radiology. 2015;45(6):820-30. 5. Linam LE, Munden M. Sonography as the first line of evaluation in children with suspected acute appendicitis. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2012;31(8):1153-7. 6. Aydin S, Tek C, Ergun E, Kazci O, Kosar PN. Acute Appendicitis or Lymphoid Hyperplasia: How to Distinguish More Safely? Can Assoc Radiol J. 2019;70(4):354-60. 7. Leeuwenburgh MM, Wiezer MJ, Wiarda BM, Bouma WH, Phoa SS, Stockmann HB, et al. Accuracy of MRI compared with ultrasound imaging and selective use of CT to discriminate simple from perforated appendicitis. The British journal of surgery. 2014;101(1):e147-55. 8. Tseng P, Berdahl C, Kearl YL, Behar S, Cooper J, Dollbaum R, et al. Does Right Lower Quadrant Abdominal Ultrasound Accurately Identify Perforation in Pediatric Acute Appendicitis? The Journal of emergency medicine. 2016;50(4):638-42. 9. Narsule CK, Kahle EJ, Kim DS, Anderson AC, Luks FI. Effect of delay in presentation on rate of perforation in children with appendicitis. The American journal of emergency medicine. 2011;29(8):890-3. 10. Lee SL, Stark R, Yaghoubian A, Shekherdimian S, Kaji A. Does age affect the outcomes and management of pediatric appendicitis? Journal of pediatric surgery. 2011;46(12):2342-5. 11. Gonzalez DO, Lawrence AE, Cooper JN, Sola R, Jr., Garvey E, Weber BC, et al. Can ultrasound reliably identify complicated appendicitis in children? The Journal of surgical research. 2018;229:76-81. 12. Blumfield E, Nayak G, Srinivasan R, Muranaka MT, Blitman NM, Blumfield A, et al. Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients. AJR American journal of roentgenology. 2013;200(5):957-62. 13. Azzali G. Three-dimensional and ultrastructural aspects of the lymphatic vascularization of the vermiform appendix. Journal of submicroscopic cytology and pathology. 1998;30(4):545-53. 14. Broker ME, van Lieshout EM, van der Elst M, Stassen LP, Schepers T. Discriminating between simple and perforated appendicitis. The Journal of surgical research. 2012;176(1):79-83.
Details
| Primary Language | English |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | ORIGINAL ARTICLES |
| Authors | |
| Publication Date | June 26, 2020 |
| Submission Date | May 6, 2020 |
| Published in Issue | Year 2020 Volume: 14 Issue: 4 |
The publication language of Turkish Journal of Pediatric Disease is English.
Manuscripts submitted to the Turkish Journal of Pediatric Disease will go through a double-blind peer-review process. Each submission will be reviewed by at least two external, independent peer reviewers who are experts in the field, in order to ensure an unbiased evaluation process. The editorial board will invite an external and independent editor to manage the evaluation processes of manuscripts submitted by editors or by the editorial board members of the journal. The Editor in Chief is the final authority in the decision-making process for all submissions. Articles accepted for publication in the Turkish Journal of Pediatrics are put in the order of publication, with at least 10 original articles in each issue, taking into account the acceptance dates. If the articles sent to the reviewers for evaluation are assessed as a senior for publication by the reviewers, the section editor and the editor considering all aspects (originality, high scientific quality and citation potential), it receives publication priority in addition to the articles assigned for the next issue.
The aim of the Turkish Journal of Pediatrics is to publish high-quality original research articles that will contribute to the international literature in the field of general pediatric health and diseases and its sub-branches. It also publishes editorial opinions, letters to the editor, reviews, case reports, book reviews, comments on previously published articles, meeting and conference proceedings, announcements, and biography. In addition to the field of child health and diseases, the journal also includes articles prepared in fields such as surgery, dentistry, public health, nutrition and dietetics, social services, human genetics, basic sciences, psychology, psychiatry, educational sciences, sociology and nursing, provided that they are related to this field. can be published.