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Ultrasonography for Diagnosis of Acute Appendicitis in Children

Journal of the Korean Pediatric Society 1996;39(4):497-502.
Published online April 15, 1996.
Ultrasonography for Diagnosis of Acute Appendicitis in Children
Mi Kyoung Lee1, Chang Sung Im1, Sun Mi An1, Chang Hee Kim1, Dong Jin Lee1, Jung Hyouk Kwon2
1Department of Pediatrics, Ulsan Dong Kang General Hospital Ulsan, Korea
2Department of Radiolog, Ulsan Dong Kang General Hospital Ulsan, Korea
소아 급성 충수염 진단에서의 복부 초음파 검사의 유용성에 관한 연구
이미경1, 임창성1, 안선미1, 김창휘1, 이동진1, 권중혁2
1울산 동강병원 소아과
2울산동강병원 방사선과
Abstract
Purpose
: Accurate clinical diagnosis of acute appendicitis is more difficult in children since they may not be able to communicate their complaints adequately, and findings on physical examination may be nonspecific.The uncertainty in diagnosis may lead to a delay of surgery or to unnecessary laparotomy. Prompt diagnosis is important due to their complications such as perforation, abscess formation, and peritonitis. The authors conducted this study in order to find out usefulness of ultrasonography in diagnosis of acute appendicitis in children.
Methods
: The authors was performed ultrasonographical examination to 290 children with abdominal pain under the age of 15 during a recent 16-months period from January 1994 to April 1995. High-resolution ultrasonography was used according to the graded compression method. The ultrasonographic findings were correlated with pathologic outcome in 87 cases.
Results
: 1) Among 290 patients with abdominal pain, acute appendicitis was 81 cases (27.9%), and there were mesenteric lymphadenitis, terminal ileitis, intussusception, acute gastroenteritis, and nonspecific findings. 2) Sex ratio of acute appendicitis was 1.53:1. The acute appendicitis was occurred 13.6% in under the age of 5 and 86.4% in over the age of 6. Mean age was 10.6 3) The most frequent symptom was abdominal pain followed by vomiting, fever, nausea, and diarrhea. 4) Leukocytosis (>10,000/cu.mm) was occurred in 71 of 81 (87.7%) cases of acute appendicitis and 24 of 28 (85.7%) cases of acute appendicitis with perforation. 5) The perforation rate was higher in delayed diagnosis and in younger children. 6) Ultrasonography had a sensitivity of 97.5%, specificity of 96.2%, positive predictive value of 90.8%, and negative predictive value of 99.0% on diagnosis in acute appendicitis.
Conclusion
: Upon the above results, the authors were able to conclude that graded compression ultrasonography had high sensitivity and specificity and was useful for the diagnosis of acute appendicitis in children. And the ultrasonography can be applied as rapid, noninvasive, and well-tolerated investigation. So, it has diagnostic value as screening test in children whose chief complaint is abdominal pain.
Key Words: Acute appendicitis, Abdominal ultrasonography


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