Sonographie bei akuter Appendizitis: Eine prospektive Studie

Abstract

In a prospective study 404 unselected patients suspected of having acute appendicitis were examined by ultrasound, the results being compared with the initial clinical findings. Acute appendicitis was established in 27.2%, confirmed by histology. The overall accuracy of ultrasonography in relation to the diagnosis of appendicitis was 95.5%, 95.1% when positive, 95.7% when negative. An acutely inflamed appendix could not be demonstrated by ultrasound in 13 patients (sensitivity 88.2%), while in five there was a false-positive ultrasound result (specificity 98.3%). Complicated appendicitis with perforation occurred in 22 patients (20%): ultrasound sensitivity in this situation was 91%. Especially when the clinical picture was unclear (34.5% of all cases of appendicitis) a definitive diagnosis of acute appendicitis was made both earlier and more certainly by ultrasonography. Further-more, in many instances ultrasound was able to demonstrate other serious disease in the differential diagnosis from acute appendicitis. Negative laparotomy rate was lowered from 21.9% to 11.4% by taking into account ultrasonographic findings. Thus ultrasonography proved to be an important method as an imaging technique and in the differential diagnosis of acute appendicitis.

Influence of ultrasonography on clinical decision making in suspected acute appendicitis in adults

“…Adhesions are thought to be even more frequent when a healthy appendix has been removed [25]. A number of studies have shown that ultrasonography, introduced as the first imaging modality in patients with suspected appendicitis, is very effective in reducing the rate of negative laparotomies [2,4,12,13,22]. Nevertheless, opinions on its use are still divided.…”

“…After the introduction of preoperative ultrasonography, when the decision for surgery no longer depended solely on the clinical impression, the proportion of negative laparotomies significantly declined [2,4,12,13]. Nevertheless, opinions are still divided as to who should perform the examination and whether it should be used routinely in all patients with suspected appendicitis or only in those with ambiguous clinical findings [1,4,6,9,12,[14][15][16][17].…”

“…ultrasound (US) and computed tomography (CT), the diagnosis of acute appendicitis was based solely on the history, clinical examination and laboratory findings, all of which are often atypical and misleading, since various other abdominal and pelvic diseases may have similar manifestations. The consequence was a high rate of negative laparotomies (operations in which normal -not inflamed -appendix was found): between 20 and 30% for the entire population and up to 47% for women of childbearing age [1][2][3][4][5][6]. The introduction of preoperative diagnostic imaging was a major turning point in the management of acute appendicitis.…”

“…*** Four patients did not undergo surgery and were discharged home after one or two days of observation. **** These are (number of patients): Meckel's diverticulits(2), perforation of the peptic ulcer…”

“…** The alternative findings were (number of patients): mesenterial lymphadenitis(14), gynecological diseases(14), urlogical diseases(11), terminal ileitis (10), other acute inflamatory diseases (enterocolitis, coecitis) (11), diverticulitis of the right colon (3), Meckel's diverticulitis(2), ileocolic invagination (2), perforation of the peptic ulcer (1), ischaemia of the colon (1), omental infarction (3). *** Four patients did not undergo surgery and were discharged home after one or two days of observation.…”