Araştırma Makalesi
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Perfore Apandisit: Ultrasonografik Bir Tanısal Zorluk

Yıl 2018, Cilt: 51 Sayı: 2, 110 - 115, 29.08.2018

Öz

Abstract:



Aim: Perforated
appendicitis (PA) cases are more common amongst pediatric population. Imaging
plays an important role in PA diagnosis; clinical distinction can be quietly
difficult, especially in younger children. Unfortunately, PA is defined as a
potential pitfall in US evaluation, because a perforated appendix usually
decompresses and becomes difficult to identify. In the current study, we mainly
aim to define diagnostic US characteristics of PA, and determine most specific
and sensitive US findings



Materials
and methods: We retrospectively evaluated the medical records and US reports of
the children who were referred to the radiology department with a clinical
diagnosis of acute appendicitis. We have recorded sedimentation (ESR), C
reactive protein (CRP), and leukocyte count. We have recorded presence of
loculated fluid in periappendiceal area, appendicolith, presence of complex
fluid, increase in echogenicity of periappendiceal fat, fluid collection in
abdominal recesses, increase in periportal liver echogenicity.



Results: Study
population consists of 132 patients.  Loculated
fluid collection in periappendiceal area, presence of appendicolith, fluid
collection in 3-4 areas, and in all five areas, ESR, and CRP values are found
to be effective for the differentiation. 
We define the combination of loculated fluid collection, presence of
ascites in all five areas, and elevation of CRP levels as the most successful
combination for detecting PA (98.2% specificity, 48.3% sensitivity).



Conclusion:
Detection of loculated fluid in periappendiceal area, and fluid collection in
all abdominal recesses is the most valuable US parameters.  Combination of these parameters with CRP
levels can increase diagnostic performance.



Keywords:
US, perforated appendicitis, diagnosis



Özet:



Amaç:
Perfore apandisit (PA) vakaları pediyatrik popülasyonda, özellikle 5 yaş altı
çocuklarda daha sık görülmektedir. Perfore apandisit vakalarında klinik pek çok
başka patoloji ile örtüşebildiğinden görüntüleme yöntemleri tanıda önem kazanmaktadır.
Ne yazık ki, perforasyon sonucu apendiks dekomprese olduğundan, ultrason
incelemesi ile perfore apandisiti tanımlamak güç olabilmektedir. Güncel
çalışmada, perfore apandisit tanısı için en yararlı sonografik parametrelerin belirlenmesi
hedeflenmiştir.



Gereç ve yöntem: Radyoloji bölümüne akut apandisit ön tanısı
ile yönlendirilen çocukların medikal kayıtları geriye dönük olarak taranmıştır.
Eritrosit sedimentasyon hızı (ESH), C reaktif protein (CRP) düzeyleri, lökosit
sayımları kaydedilmiştir. Ayrıca sonografik paramatreler olarak; apendiks
çevresinde lokule sıvı varlığı, apendikolit tespiti, kompleks serbest sıvı
bulunması, periapendisyel yağ dokuda ekojenite artışı olması, abdominal
reseslerde asit tespit edilmesi ve periportal ekojenite artışı olması
belirlenmiştir.



Bulgular:
Araştırma popülasyonu 132 hastadan oluşmaktadır. Apendiks çevresinde lokule
koleksiyon tespit edilmesi, apendikolit varlığı, 3-4 abdominal reseste sıvı
bulunması, tüm abdominal reseslerde sıvı bulunması, ESH, CRP değerlerinde artış
olması parametreleri PA varlığını başarı ile öngörmektedir. Ayrıca, apendiks
çevresinde lokule koleksiyon tespit edilmesi, tüm abdominal reseslerde sıvı
bulunması ve CRP değerlerinde artış olması paramaterelerinin kombinasyonu
(%98.2 spesifik, %48.3 sensitf),  PA
tanısında oldukça yararlı bulunmuştur.



Sonuç:  Apendiks çevresinde lokule koleksiyon tespit
edilmesi ve tüm abdominal reseslerde sıvı bulunması en değerli sonografik
parametrelerdir. Bu parametrelere CRP değerinin de eklenmesi tanısal başarıyı
arttırabilir.



Anahtar
kelimeler: Ultrason, perfore apandisit, tanı

Kaynakça

  • References: 1. Gwynn LK (2001) The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. J Emerg Med 21 (2):119-1232. Shogilev DJ, Duus N, Odom SR, Shapiro NI (2014) Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med 15 (7):859-871. doi:10.5811/westjem.2014.9.215683. Strouse PJ (2010) Pediatric appendicitis: an argument for US. Radiology 255 (1):8-13. doi:10.1148/radiol.100911984. Gonzalez DO, Lawrence AE, Cooper JN, et al. (2018) Can ultrasound reliably identify complicated appendicitis in children? J Surg Res 229:76-81. doi:10.1016/j.jss.2018.03.0125. Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132 (5):910-9256. Tulin-Silver S, Babb J, Pinkney L, Strubel N, et al. (2015) The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity. Pediatr Radiol 45 (6):820-830. doi:10.1007/s00247-014-3232-57. Kaiser S, Frenckner B, Jorulf HK (2002) Suspected appendicitis in children: US and CT--a prospective randomized study. Radiology 223 (3):633-638. doi:10.1148/radiol.22330110768. Peletti AB, Baldisserotto M (2006) Optimizing US examination to detect the normal and abnormal appendix in children. Pediatr Radiol 36 (11):1171-1176. doi:10.1007/s00247-006-0305-09. Quillin SP, Siegel MJ, Coffin CM (1992) Acute appendicitis in children: value of sonography in detecting perforation. AJR Am J Roentgenol 159 (6):1265-1268. doi:10.2214/ajr.159.6.144239810. Borushok KF, Jeffrey RB, Jr., Laing FC, Townsend RR (1990) Sonographic diagnosis of perforation in patients with acute appendicitis. AJR Am J Roentgenol 154 (2):275-278. doi:10.2214/ajr.154.2.210501311. Narsule CK, Kahle EJ, Kim DS, Anderson AC, Luks FI (2011) Effect of delay in presentation on rate of perforation in children with appendicitis. Am J Emerg Med 29 (8):890-893. doi:10.1016/j.ajem.2010.04.00512. Sivit CJ, Siegel MJ, Applegate KE, Newman KD (2001) When appendicitis is suspected in children. Radiographics 21 (1):247-262; questionnaire 288-294. doi:10.1148/radiographics.21.1.g01ja1724713. Anderson JE, Bickler SW, Chang DC, Talamini MA (2012) Examining a common disease with unknown etiology: trends in epidemiology and surgical management of appendicitis in California, 1995-2009. World J Surg 36 (12):2787-2794. doi:10.1007/s00268-012-1749-z14. Yousef Y, Youssef F, Dinh T, et al. (2018) Risk stratification in pediatric perforated appendicitis: Prospective correlation with outcomes and resource utilization. J Pediatr Surg 53 (2):250-255. doi:10.1016/j.jpedsurg.2017.11.02315. Carpenter JL, Orth RC, Zhang W, Lopez ME, Mangona KL, Guillerman RP (2017) Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study. Radiology 282 (3):835-841. doi:10.1148/radiol.201616017516. Thoeni RF (1995) The role of imaging in patients with ascites. AJR Am J Roentgenol 165 (1):16-18. doi:10.2214/ajr.165.1.778557617. Yoon HM, Kim JH, Lee JS, Ryu JM, Kim DY, Lee JY (2018) Pediatric appendicitis with appendicolith often presents with prolonged abdominal pain and a high risk of perforation. World J Pediatr 14 (2):184-190. doi:10.1007/s12519-018-0128-818. Broker ME, van Lieshout EM, van der Elst M, Stassen LP, Schepers T (2012) Discriminating between simple and perforated appendicitis. J Surg Res 176 (1):79-83. doi:10.1016/j.jss.2011.09.049
Yıl 2018, Cilt: 51 Sayı: 2, 110 - 115, 29.08.2018

Öz

Kaynakça

  • References: 1. Gwynn LK (2001) The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. J Emerg Med 21 (2):119-1232. Shogilev DJ, Duus N, Odom SR, Shapiro NI (2014) Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med 15 (7):859-871. doi:10.5811/westjem.2014.9.215683. Strouse PJ (2010) Pediatric appendicitis: an argument for US. Radiology 255 (1):8-13. doi:10.1148/radiol.100911984. Gonzalez DO, Lawrence AE, Cooper JN, et al. (2018) Can ultrasound reliably identify complicated appendicitis in children? J Surg Res 229:76-81. doi:10.1016/j.jss.2018.03.0125. Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132 (5):910-9256. Tulin-Silver S, Babb J, Pinkney L, Strubel N, et al. (2015) The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity. Pediatr Radiol 45 (6):820-830. doi:10.1007/s00247-014-3232-57. Kaiser S, Frenckner B, Jorulf HK (2002) Suspected appendicitis in children: US and CT--a prospective randomized study. Radiology 223 (3):633-638. doi:10.1148/radiol.22330110768. Peletti AB, Baldisserotto M (2006) Optimizing US examination to detect the normal and abnormal appendix in children. Pediatr Radiol 36 (11):1171-1176. doi:10.1007/s00247-006-0305-09. Quillin SP, Siegel MJ, Coffin CM (1992) Acute appendicitis in children: value of sonography in detecting perforation. AJR Am J Roentgenol 159 (6):1265-1268. doi:10.2214/ajr.159.6.144239810. Borushok KF, Jeffrey RB, Jr., Laing FC, Townsend RR (1990) Sonographic diagnosis of perforation in patients with acute appendicitis. AJR Am J Roentgenol 154 (2):275-278. doi:10.2214/ajr.154.2.210501311. Narsule CK, Kahle EJ, Kim DS, Anderson AC, Luks FI (2011) Effect of delay in presentation on rate of perforation in children with appendicitis. Am J Emerg Med 29 (8):890-893. doi:10.1016/j.ajem.2010.04.00512. Sivit CJ, Siegel MJ, Applegate KE, Newman KD (2001) When appendicitis is suspected in children. Radiographics 21 (1):247-262; questionnaire 288-294. doi:10.1148/radiographics.21.1.g01ja1724713. Anderson JE, Bickler SW, Chang DC, Talamini MA (2012) Examining a common disease with unknown etiology: trends in epidemiology and surgical management of appendicitis in California, 1995-2009. World J Surg 36 (12):2787-2794. doi:10.1007/s00268-012-1749-z14. Yousef Y, Youssef F, Dinh T, et al. (2018) Risk stratification in pediatric perforated appendicitis: Prospective correlation with outcomes and resource utilization. J Pediatr Surg 53 (2):250-255. doi:10.1016/j.jpedsurg.2017.11.02315. Carpenter JL, Orth RC, Zhang W, Lopez ME, Mangona KL, Guillerman RP (2017) Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study. Radiology 282 (3):835-841. doi:10.1148/radiol.201616017516. Thoeni RF (1995) The role of imaging in patients with ascites. AJR Am J Roentgenol 165 (1):16-18. doi:10.2214/ajr.165.1.778557617. Yoon HM, Kim JH, Lee JS, Ryu JM, Kim DY, Lee JY (2018) Pediatric appendicitis with appendicolith often presents with prolonged abdominal pain and a high risk of perforation. World J Pediatr 14 (2):184-190. doi:10.1007/s12519-018-0128-818. Broker ME, van Lieshout EM, van der Elst M, Stassen LP, Schepers T (2012) Discriminating between simple and perforated appendicitis. J Surg Res 176 (1):79-83. doi:10.1016/j.jss.2011.09.049
Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Araştırma Makalesi
Yazarlar

Sonay Aydın

Erdem Fatihoğlu

Yayımlanma Tarihi 29 Ağustos 2018
Gönderilme Tarihi 19 Eylül 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 51 Sayı: 2

Kaynak Göster

AMA Aydın S, Fatihoğlu E. Perfore Apandisit: Ultrasonografik Bir Tanısal Zorluk. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. Ağustos 2018;51(2):110-115.