CORRELATION OF ULTRASONOGRAPHY FINDINGS OF WALL PATTERN AND DISCONTINUITY OF WALL WITH PER-OPERATIVE FINDING FOR PERFORATION OF APPENDIX
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 17
Abstract
BACKGROUND Ultrasonography is widely used for diagnosis of appendicitis.[1-4] There have been not much literature for diagnosing perforated appendicitis by evaluating wall pattern and wall thickness by USG. In this study, we evaluated wall thickness and wall pattern for diagnosing perforated appendix. Aims and Objectives- Ultrasonography characterisation of wall pattern in inflamed appendix compared to normal appendix. Correlation of wall pattern and discontinuity of wall of perforated and non-perforated appendicitis with post-operative findings. MATERIALS AND METHODS Study Type- Observational Diagnostic Study. Study of the role of ultrasonography in characterisation of wall pattern and wall thickness in inflamed appendix in correlation with per-operative findings. Wall pattern of appendix is classified into thickened wall with preservation of or intact wall pattern, diffuse loss of normal wall pattern and focal discontinuity in submucosal layer. Study was conducted in the period, September 2015 to April 2017. 200 patients with positive findings for appendicitis by ultrasonography were selected for this study. Scanning RIF with graded compression technique with Transducers Linear Array 6 MHz to 11 MHz and curvilinear array 3.0 to 6 MHz. Patients are excluded who presented with symptoms related to other organ systems and when ultrasound was not used as an initial evaluation of method. Any patient having excessive bowel gas, in whom visualisation of appendix becomes difficult, is excluded from the study. Ultrasonography findings are correlated only with peroperative finding. RESULTS At surgery 52 (26%) of the 200 patients proved to have perforated appendicitis and 148 patients (76%) did not have perforated appendicitis. Focal discontinuity and loss of normal wall pattern are common if diameter of appendix is more than 8 mm, though it may present in lesser diameter. When there is only thickened wall with no discontinuity, the specificity to rule out perforation is 100% with confidence interval of 16% to 100%. As there is no perforation by USG in this table, sensitivity is 0%. The sensitivity to diagnose perforation in focal discontinuity of submucosal layer is 89% and specificity is 75% with accuracy of 76.92%. The sensitivity to diagnose perforation in diffuse loss of wall pattern is 68% (CI 50% to 83%) and specificity is 80% (CI- 44% to 97%) with accuracy of 71% (CI- 55.42% to 84.28%). Sensitivity and accuracy of detecting perforation by USG is highest for focal discontinuity in submucosal layer of appendix. Sensitivity for non-perforated appendicitis is high for intact wall pattern with thickened wall. CONCLUSION Ultrasonography is widely used to diagnose acute appendicitis. Just to diagnose appendicitis may not be adequate for the surgeon to plan the management. Status regarding perforation may be very important for further management. This is the first attempt to find correlation between wall pattern and wall thickness for perforation. Focal discontinuity in submucosal layer of appendix has more sensitivity for perforation. The sensitivity to diagnose perforation by diffuse loss of normal wall pattern is also good, but comparatively less than focal discontinuity in submucosal layer of appendix. Ultrasonography evaluation of wall thickness and wall pattern in appendicitis may be included in routine practice to give ideas for the surgeon for further management of appendicitis.
Authors and Affiliations
Venugopal Kodumur, Krishna Kumar Rama Krishnan, Parthiban N
Keywords
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- EP ID EP415207
- DOI 10.14260/jemds/2018/472
- Views 78
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