Sonographic Differentiation of Complicated From Uncomplicated Appendicitis: Implications for Antibiotics-First Therapy.

Autor: Xu Y; Department of Radiology, Stanford University School of Medicine, Stanford, California, USA., Jeffrey RB; Department of Radiology, Stanford University School of Medicine, Stanford, California, USA., Chang ST; Department of Radiology, Stanford University School of Medicine, Stanford, California, USA., DiMaio MA; Department of Pathology, Stanford University School of Medicine, Stanford, California, USA., Olcott EW; Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
Jazyk: angličtina
Zdroj: Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine [J Ultrasound Med] 2017 Feb; Vol. 36 (2), pp. 269-277. Date of Electronic Publication: 2016 Dec 31.
DOI: 10.7863/ultra.16.03109
Abstrakt: Objectives: To evaluate sonographic findings as indicators of complicated versus uncomplicated appendicitis in the setting of known appendicitis, a necessary distinction in deciding whether to proceed with antibiotic therapy or with appendectomy.
Methods: With Institutional Review Board approval and Health Insurance Portability and Accountability Act compliance, appendiceal sonograms of 119 patients with histopathologically proven appendicitis were retrospectively blindly reviewed to determine the presence or absence of the normally echogenic submucosal layer, the presence of mural hyperemia, periappendiceal fluid, appendicoliths, and hyperechoic periappendiceal fat and to determine the maximum outside diameter. Results were compared with the presence of complicated versus uncomplicated appendicitis on histopathologic examination and assessed by both univariate and mulitvariate logistic regression; confidence intervals (CIs) of proportions were assessed by the exact binomial test.
Results: Thirty-two (26.9%) of the 119 patients had complicated appendicitis, including 11 with gangrenous appendicitis without perforation and 21 with gangrenous appendicitis and perforation. Loss of the submucosal layer was the only independent significant indicator of complicated appendicitis in multivariate regression (P < .001) and provided sensitivity and specificity values of 100.0% (95% CI, 89.1%-100.0%) and 92.0% (95% CI, 84.1%-96.7%), respectively.
Conclusions: Loss of the normally echogenic submucosal layer was the most useful sonographic finding for discriminating complicated from uncomplicated appendicitis, being the only finding independently and significantly associated with complicated appendicitis and, additionally, providing both high sensitivity and high specificity. This information may help a physician decide whether to proceed with antibiotic therapy or with appendectomy when treating a patient with appendicitis.
(© 2016 by the American Institute of Ultrasound in Medicine.)
Databáze: MEDLINE
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