The Prognostic Value of Ultrasound Findings in Preoperatively Distinguishing between Uncomplicated and Complicated Types of Pediatric Acute Appendicitis Based on Correlation with Intraoperative and Histopathological Findings

Abstract

Objective: This study compares the preoperative ultrasound findings of all children with a clinical picture of acute appendicitis on the basis of intraoperative and histopathological findings to assess the feasibility of this approach in preoperatively distinguishing between uncomplicated and complicated cases. Methods: This retrospective study includes 224 pediatric patients who underwent ultrasound prior to appendectomy at our institution between January 2016 and February 2022. Logistic regression analysis was used to investigate the association between sonographic and intraoperative histopathological findings. Results: Of the 224 participants, 61.1% were intraoperatively diagnosed with uncomplicated appendicitis (59.8% male). Multivariate logistic regression analysis revealed that patients with a higher appendiceal diameter, presence of appendicolith, and peritonitis were more likely to suffer from complicated appendicitis. Finally, the common anatomical position of the appendix and an appendiceal diameter greater than 6 mm had the highest sensitivity (94.6% and 94.5%, respectively) for predicting complicated appendicitis, with the most specific (99.3%) sonographic finding being the existence of an abscess. Conclusions: Preoperative abdominal ultrasound in children with a clinical diagnosis of acute appendicitis can distinguish between uncomplicated and complicated appendicitis in most cases of pediatric appendicitis. A higher appendiceal diameter, the presence of appendicolith, and peritonitis are parameters noted by ultrasound that strongly predict complicated appendicitis.

Predicting severity of acute appendicitis with machine learning methods: a simple and promising approach for clinicians

“…Hence, we analyzed CT and US reports for AppD and PALC. Recent studies showed that AppD is important for both simple AA [40] and complicated AA [41] diagnoses. The median AppD was significantly higher in the perforated AA group, which is consistent with recent studies.…”

Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score)

“…Furthermore, indirect signs were recorded. These signs were free fluid surrounding the appendix, local abscess formation, increased echogenicity and/or uncompressible local mesenteric fat, enlarged local mesenteric lymph nodes, signs of secondary small bowel obstruction, and thickening of the peritoneum [ 22 ]. However, in the present study, all cases where the appendix was not recognized were removed.…”

“…In this study, which is a continuation of our previous study, we retrospectively examined the records of patients aged 0–14 years who were hospitalized in the Pediatric Surgery Department of Alexandroupolis University Hospital, Democritus University of Thrace, in order to design a new predictive score for complicated appendicitis [ 22 ]. The study included children who had clinical examination of abdominal pain (description of pain, anorexia, body temperature, nausea or vomiting, duration of symptoms) laboratory findings on admission (white blood cell (WBC), platelets (PLT), neutrophils (NEUT), C-reactive protein (CRP)) preoperative abdominal US, and histopathological report after an operation for AA (between January 2016 and February 2022).…”

“…Specifically, patients were excluded due to missing data ( n = 14), non-acute appendectomy ( n = 5), histopathologically confirmed carcinoid or other pathology ( n = 3) non identified appendix in US ( n = 25), and negative histopathology ( n = 5). Methods of histopathological and US examination of our patients are well described in our previous study [ 22 ].…”

The application value of high-frequency ultrasound in the feasibility assessment of endoscopic retrograde appendicitis therapy in children with appendicitis

“…Appendicitis in children develops rapidly, from abdominal pain and appendicitis to purulence and perforation. The duration of the disease is only a few hours [6] [7] . Although the appendix is small, it still plays an important role in the human body.…”