Diagnostic accuracy of secondary echosonographic sign of the pediatric appendicitis

Abstract

Background: Acute appendicitis is common surgical problem in Pediatric practice. Most pediatric patient who were hospitalized with acute abdominal pain were suspected with diagnosis acute appendicitis.Percentage of misdiagnosis with acute appendicitis among pediatric patients are 30%.Percentage of misdiagnosis during first examination among patients under 12 years of age are in wide range 12-57%.In order to decrease misdiagnosis with acute appendicitis surgeons administer additional diagnostic tests as Ultrasound, CT scan and ets..Our retrospective study aimed to establish significance of secondary contributing Ultrasound findings when appendix isn’t visualized during of the ultrasonography. Materials and Method: This study was included 480 patients who underwent appendectomy with clinical diagnosis of acute appendicitis in Pediatric Surgery Department of Maternity and Child National Health Center between May, 2019-November, 2019. We selected patients under age of 18 who went USG before surgery, with or without clear visualization of appendix. All diagnosis were confirmed with pathology. We analyzed specificity, sensitivity, positive predictive value, negative predictive value each secondary ultrasound findings. Result: Average age of study subjects were 10.58 (1.6-18 years old). 269 (56%) were male and 211(44%) were female patients. Gender ratio was 1.3:1. All underwent USound examination before surgery. 254 cases were with clear visualization of appendix. There was 226 cases without clear visualization of appendix on US exam. Among them 190 patient’s diagnosis with acute appendicitis were confirmed by pathology findings, 36 patient’s diagnosis wasn’t confirmed by pathology. Among this 226 cases without visualization of appendix on US exam there are 202 cases were with secondary US findings, (free fluid in abdominal cavity,enlarged lymph nodes, abnormal echogenicity of mesenteric fat, gas filled bowl surrounding of appendix location) and 24 cases were without secondary US findings. Among these 24 cases 2 patients were with confirmed diagnosis of AA. Conclusion: Contribution of US finding in diagnosis of acute appendicitis appears to be high.Presence of one secondary symptoms on US exam with or without visualization of appendix increases chances of right diagnosis to 90%. Appearance of 3 or more secondary symptoms on US exam increases persentage of right diagnosis up to 100%.