Margain PMÁ, Vera RF, Dimas UN

Language: Spanish
References: 15
Page: 65-70
PDF size: 226.30 Kb.

ABSTRACT

Introduction: Practitioners who see patients with acute abdominal complaints are commonly faced with making the diagnosis of appendicitis. While sometimes the history and physical examination are sufficient, frequently some diagnostic confirmation will be necessary. Abdominal computed tomography scans and ultrasound scans have been shown to be accurate in the diagnosis of acute appendicitis. Today the literature has begun to focus on which patients should undergo imaging studies. Objective: Determine the diagnostic accuracy of ultrasound in appendicitis. Material and methods: Of 173 patients, 118 (68.2%) underwent ultrasound on suspicion of appendicitis. Findings were correlated to the suggestive or positive observed and reported by ultrasound. In 51 patients (29.4%) it was not necessary, and only four cases (2.3%) required tomography. Results: The ultrasound was not positive in 16.1%, and support of tomography was required. In more than 83% where it was possible to identify findings suggestive of appendicitis, it correlated and coincided with the histopathological reports. Conclusions: Abdominal ultrasound in appendicitis is useful in all cases, even more in the cases of diagnostic doubt, with unclear clinical presentation and laboratory results.

REFERENCES

1. Brunicardi FC, Andersen DK, Billiar TR. Apéndice. En: Schwartz. Principios de cirugía. 9th ed. New York, EUA: McGraw-Hill, Inc.; 2010: 1119-1136.

2. Graffeo C, Counselman F. Appendicitis. Emergency Medicine Clinics. 1996; 14: 653-667.

3. Velásquez C et al. Valor del ultrasonido en el diagnóstico y manejo de la apendicitis aguda. Rev Gastroenterol Peru. 2007; 27: 259-263.

4. Denizbasi A, Unluer EE. The role of the emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis compared with the general surgery resident. Eur J Emerg Med. 2003; 10: 296-301.

5. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986; 15: 557-564.

6. Fox C, Solley M, Anderson C, Zlidenny A et al. Prospective evaluation of emergency physician performed bedside ultrasound to detect acute appendicitis. Eur J Emerg Med. 2008; 15: 80-85.

7. Schuh S et al. Predictors of non-diagnostic ultrasound scanning in children with suspected appendicitis. J Pediatr. 2011; 158: 112-118.

8. Cuschieri J, Florence M, Flum D, Jurkovich G et al. Negative appendectomy and imaging accuracy in the Washington state surgical care and outcomes assessment program. Ann Surg. 2008; 248: 557-563.

9. Shin LK, Jeffrey BR. Sonography and computed tomography of the mimics of appendicitis. Ultrasound Q. 2010; 26: 201-210.

10. Poortman P et al. Improving diagnosis of acute appendicitis: results of a diagnostic pathway with standard use of ultrasonography followed by selective use of CT. J Am Coll Surg. 2009; 208 (3): 434-441.

11. Jang K, Lee K, Kim MJ, Yoon HS et al. What is the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after CT? Eur J Radiol. 2010; 74: 71-76.

12. Nelson D, Causey M, Porta C, McVay D et al. Examining the relevance of the physician’s clinical assessment and the reliance on computed tomography in diagnosing acute appendicitis. Am J Surg. 2013; 205: 452-456.

13. Stewart J, Olcott E, Jeffrey B. Sonography for appendicitis: nonvisualization of the appendix is an indication for active clinical observation rather than direct referral for computed tomography. J Clin Ultrasound. 2012; 40: 455-461.

14. Chan L, Shin L, Pai R, Jeffrey R. Pathologic continuum of acute appendicitis: sonographic findings and clinical management implications. Ultrasound Q. 2011; 27: 71-79.

15. Larson J, Peirce J, Ellinger D, Parish G et al. The validity and utility of sonography in the diagnosis of appendicitis in the community setting. AJR Am J Roentgenol. 1989; 153: 687-691.