Use of sonography in diagnosing acute appendicitis: Comparison of a teaching hospital and a community hospital

Sabra, John; Roh, Michael H.; Páez, Ximena; Cronan, John J.

doi:10.1016/s1076-6332(05)80682-8

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Noninvasive imaging is an integral part of the evaluation of right-lower-quadrant pain in almost 40 percent of patients in both teaching and nonteaching hospitals. 1 The use of imaging for the prospective evaluation of pain in the right lower quadrant in children of this patient's age remains controversial. 2 Some experienced pediatric surgeons believe that observation of the clinical course and physical findings over time is preferable for the diagnosis of appendicitis.…”

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confidence: 99%

Case 21-2000

Tracy¹,

F²

2000

N Engl J Med

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A 13-year-old boy was admitted to the hospital three years and eight months before the diagnostic procedure because of abdominal pain.Periumbilical pain had begun the day before the initial admission, after the patient had eaten cookies and an apple. He slept poorly that night, and by the next morning the pain had shifted to the right lower quadrant of the abdomen. During that day the temperature remained normal. In midafternoon he vomited 240 ml of red liquid after consuming a soft drink and was brought to this hospital. There was no history of fever, sweats, chills, nausea, vomiting, urinary frequency, dysuria, or hematuria.The temperature was 35°C, the pulse was 110, and the respirations were 18. The blood pressure was 110/60 mm Hg.Physical examination showed tenderness in the right lower abdominal quadrant, without signs of peritoneal irritation. The results of a rectal examination were normal. The external genitalia appeared normal. The urine was positive (+++) for ketones. Laboratory tests were performed (Tables 1 and 2). Abdominal radiographs revealed fecal debris in the colon. By the second hospital day, the pain had disappeared, and the findings on examination of the abdomen were normal. The patient was able to eat and was discharged home.Eight months later, his penis and scrotum became swollen. Treatment with antibiotics and corticosteroid ointment did not reduce the swelling. The patient returned to this hospital. He had no history of trauma, sexual contact, pain in the genital area, or travel to exotic areas, and there was no family history of lymphedema. Examination revealed soft, puffy swelling at the base of the penis, without evidence of inflammation. There was no edema of the legs. A retrograde urographic study with a voiding cystourethrogram showed slight narrowing of the urethral meatus without proximal dilatation, posterior urethral valves, and slight trabeculation of the bladder wall. No ureteral reflux was detected, and only a small residual volume of urine was present after voiding. Cystoscopic examination revealed narrowing of the urethral meatus and moderate trabeculation of the bladder. A small bladder diverticulum was excised, and urethral dilation and a meatotomy were performed.Examination two weeks later revealed increased edema in the area of the prepuce and the median raphe of the scrotum. Nonpurpuric cutaneous lesions were noted on the thighs. One month later, the edema was unchanged. A renal ultrasonographic study showed extensive soft-tissue swelling around the corpora cavernosum; the kidneys and bladder appeared normal. A computed tomographic (CT) scan of the abdo-*To convert the values for iron and iron-binding capacity to micromoles per liter, multiply by 0.1791.

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confidence: 99%

Case 21-2000

Tracy¹,

F²

2000

N Engl J Med

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“…Im Rahmen der Ostdeutschen Multizenterstudie konnte im klinischen Alltag nur eine Sensitivität von 21 % erreicht werden [29]. Somit lässt die Sonographie lediglich wichtige differenzialdiagnostische Aussagen (Cholelithiasis, Nephrolithiasis, freie Flüssigkeit) zu [21,33,38].…”

Section: Akutes Abdomenunclassified

Der Stellenwert der Laparoskopie beim akuten Abdomen und Abdominaltrauma

Meyer¹,

Koch²,

Überrück³

et al. 2003

Viszeralchirurgie

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ZusammenfassungZiel der Untersuchung war es, den Stellenwert der Laparoskopie im Versorgungsablauf des Bauchverletzten und beim akuten Abdomen zu bestimmen. Für die Beurteilung des Stellenwertes der Laparoskopie beim Abdominaltrauma wurde das Krankengut der Chirurgischen Klinik des Carl-Thiem-Klinikums Cottbus aus den Jahren 1998 bis 2002 retrospektiv analysiert. In diesem Zeitraum wurden 104 Patienten wegen eines Bauchtraumas operativ versorgt, davon 33 (31,7 %) primär laparoskopiert. In 18 Fällen wurde der abdominelle Eingriff ohne Konversion laparoskopisch beendet, bei 10 Patienten dabei intraabdominelle Verletzungen laparoskopisch versorgt. Die Rate der so genannten "negativen" Laparotomien lag bei 7,7 %. Beim akuten Abdomen besteht die wichtigste Indikation zur diagnostischen Laparoskopie in der Abklärung unklarer rechtsseitiger Unterbauchbeschwerden. Aber auch in Einzelindikationen (mesenteriale Durchblutungsstörungen, Perforationen, Meckelsches Divertikel, gynäkologische Erkrankungen, Peritonitis unklarer Genese, Dünndarmileus) stellt die diagnostische Laparoskopie ein wichtiges diagnostisches Instrument mit therapeutischer Option dar. Anhand der Daten einer Multizenterstudie mit 1703 diagnostischen Laparoskopien bei Verdacht auf Appendizitis wird der Stellenwert der diagnostischen Laparoskopie im Rahmen der Appendizitisbehandlung dargestellt. Gute Einzelindikationen werden in Falldarstellungen und Literaturanalysen erörtert. Damit sollte die Laparoskopie unserer Meinung nach einen festen Platz im diagnostischen und gegebenenfalls therapeutischen Prozedere beim Bauchtrauma und akuten Abdomen einnehmen. SchlüsselwörterAkutes Abdomen · Bauchtrauma · diagnostische Laparoskopie · laparoskopische Therapie Abstract Key words Acute abdomen · blunt abdominal trauma · diagnostic laparoscopy · laparoscopic treatment Originalarbeit 137 Heruntergeladen von: WEST VIRGINIA UNIVERSITY. Urheberrechtlich geschützt.

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“…Abdominal ultrasonography in adults [11,12,13,14] with suspected appendicitis [15] has been associated with sensitivities in the range of 39±98 % [16,17,18,19,20]. Barloon and colleagues described findings in 22 pregnant patients with suspected appendicitis, resulting in 2 true positive, 18 true negative, 1 false positive and 1 false negative sonogram [21].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic imaging of suspected appendicitis in pregnant women: comparison of CT to ultrasonography

Mullins

Rhea

Greene

et al. 2001

Emergency Radiology

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Purpose: To compare the sensitivity and specificity of CT versus ultrasonography for the diagnosis of appendicitis in a population of pregnant women. Materials and methods: Radiology records (1988±1999) were searched for results of examinations performed on pregnant patients with suspected appendicitis. Subjects included only women with known intrauterine pregnancies. Thirty-two pregnant women were identified who had been studied by CT, ultrasound, or both. Ten patients had undergone focused abdominal CT with colon contrast, while 29 had undergone abdominal or pelvic ultrasonography with attention to the appendix. Results were compared to surgical pathology or follow-up findings. Results: CT sensitivity was 100 %, specificity 100 %, positive predictive value (PPV) 100 %, negative predictive value (NPV) 100 % and accuracy was 100 %. Ultrasound sensitivity was 100 %, specificity 83 %, PPV 50 %, NPV 100 %, and accuracy 21 %. Conclusion: In this small cohort of gravid females with suspected appendicitis, the sensitivity of focused abdominal CT with colon contrast was equal to that in the nonpregnant patient. In contradistinction to this, abdominal ultrasonography was frequently indeterminate. We hypothesize that ultrasonography is less accurate due to body habitus and the variable location of the appendix during pregnancy.

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Use of sonography in diagnosing acute appendicitis: Comparison of a teaching hospital and a community hospital

Cited by 4 publications

References 9 publications

Case 21-2000

Case 21-2000

Der Stellenwert der Laparoskopie beim akuten Abdomen und Abdominaltrauma

Diagnostic imaging of suspected appendicitis in pregnant women: comparison of CT to ultrasonography

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