The importance of ultrasound in the diagnosis of acute appendicitis : the prevention of unnecessary abdominal surgery

Abstract EN

Objectivs : The aim of the study was to assess the value of sonography in identifying the normal appendix and determining abnormality.

Methods : The appendiceal wall thickness of less than 3 mm and the intraluminal contents and luminal diameter of less than 6 mm were used as the primary criteria for normal in order to determine the appendiceal condition in 320 appendices.

In patients who underwent appendectomy, surgical and histopathologic findings were correlated with ultrasound findings.

In those who did not have surgery, the reference standard was based on follow up.

Results : A total of 223 patients of 320 with normal sonographic findings did not undergo appendectomy and recovered spontaneously.

An abnormal appendix was detected in 63 cases, which were verified surgically.

Five cases were falsely detected by ultrasound due to luminal dilatation by non comprisable inspissated feces which resulted in an outer appendiceal diameter of more than 6 mm.

They were managed surgically and the histopathological examination revealed a non-inflamed appendix.

Nine cases were falsely interpreted as negative and detected at surgery.

Conclusion : A normal appendix can be visualized in a high percentage of cases and it may present with a luminal diameter of more than 6 mm, the widely accepted upper limit of normal, due to the inspissated fecal material within the lumen.

A significant percentage of cases of early appendicitis can resolve spontaneously especially when the inflammation is confined to the appendiceal tip.