Role of Ultrasonography with Graded Compression Technique in Diagnosis of Acute Appendicitis

Abstract

Acute appendicitis is a common clinical problem. Accurate and prompt diagnosis is essential to minimize morbidity. While the clinical diagnosis may be straightforward in patients who present with classic signs and symptoms, however occasionally, the clinical diagnosis is atypical and other causes should be considered . Graded compression ultrasonography (US) is a highly accurate mean of establishing the diagnosis. The purpose of this research is to assess the role of US in diagnosis of acute appendicitis.

In this study, we reviewed the gross anatomy of the appendix, sonographic anatomy of the appendix , pathology of appendicitis , US findings of pathological lesions of the appendix , methods of diagnosis of acute appendicitis , clinical , laboratory , radiological , diagnostic ultrasound of the appendix , and laparoscopy , and also we reviewed the differential diagnosis of appendicitis

Two hundreds and fifty patients with clinical suspicion of acute appendicitis were randomized into two groups. The first group included those patients with final diagnosis of acute appendicitis and the other group included those patients with final alternative diagnosis to acute appendicitis. US accurately diagnosed (US – based true-positive) 176 patients (91%) out of 194 patients with final diagnosis of AA including accurate diagnosis of 142 patients from 149 patients (95.2%) with final diagnosis of acute non-perforated appendicitis and 34 patients from 45 patients (76.6%) with final diagnosis of perforated appendicitis . In addition US diagnosed most cases with alternative diagnosis to acute appendicitis. We discussed our results and found that US was of great value in diagnosing acute appendicitis and it decreases the negative appendectomy rate and improved the clinical outcome. We illustrated 21 representative cases done in our study. We recommend correlation of the US diagnosis with the clinical and laboratory findings and CT study for the appendix in complicated acute appendicitis or negative US findings with strong clinical evidence of acute appendicitis.