Ultrasound study of acute appendicitis in children with emphasis upon the diagnosis of retrocecal appendicitis

Abstract

Acute appendicitis in children frequently presents equivocal clinical manifestations. Delay of the proper diagnosis and unnecessary laparotomies are common. Abdominal ultrasound has proved to be useful in the diagnosis of acute appendicitis in adults. We have performed a preoperative ultrasound study in 368 children with acute appendicitis. Among the, 92 had a retrocecal appendicitis. Ultrasound established the correct diagnosis in 92.6% of patients, and in 94.5% of those with a retrocecal appendicitis. At our institution an abdominal sonography is performed on any child with a doubtful clinical diagnosis of acute appendicitis, helping the surgeon to take the decision to perform a laparotomy.

Appendicitis score for children with suspected appendicitis. A randomized clinical trial

“…However, imaging techniques such as ultrasonography and computed tomography have been suggested to increase the diagnostic accuracy and decrease the rate of unnecessary appendicectomy in children. Three prospective studies using ultrasonography documented a sensitivity of 88-93% and specificity of 96-97% in diagnosing AA [15][16][17], and the authors of these studies recommended the use of ultrasonography as an adjunct in equivocal cases. In contrast, two studies have shown that there would be no role for ultrasonography where clinical evidence is convincing, given the known false-negative rate of ultrasonography and the knowledge that the technique may delay surgical treatment [18].…”

Right perinephric abscess: a rare presentation of ruptured retrocecal appendicitis

“…Because of its retrocecal position, the clinical symptoms and signs of patients with acute retrocecal appendicitis are always atypical and confusing [17]. Therefore, delay in the diagnosis is common in this group of patients [17]. According to Rappaport et al [18], appendicitis in children untreated for more than 48 h had a perforation rate of 98%.…”

“…Ceres et al [17] reported that retrocecal appendicitis occurs in approximately 28% of children with acute appendicitis. Because of its retrocecal position, the clinical symptoms and signs of patients with acute retrocecal appendicitis are always atypical and confusing [17]. Therefore, delay in the diagnosis is common in this group of patients [17].…”

Sonography of acute appendicitis in childhood: perforation versus nonperforation

“…Furthermore, progression of acute appendicitis to frank perforation is more rapid in the younger child, some· times occurring within 6 to 12 hours. 22 Thus, the rate of perforation in the preschool child can be as high as 703 , 13 in comparison to the overall figure of 30% for children 24 and 21 to 22% for adults. 20 In infancy and childhood, the appendix frequently becomes decompressed after perforation, and the inflammatory process may not •wall oW or form a well-defined abscess, as is typically seen in the adult patient.~ Because of this, different sonographic findings will be present in children and must be recognized.…”