Ultrasound diagnosis of appendicitis

This is an automatically translated article.

The article is expertly consulted by Master, Doctor Luu Thi Bich Ngoc - Doctor of Radiology - Department of Diagnostic Imaging and Nuclear Medicine - Vinmec Times City International General Hospital.
Pelvic appendicitis is a common surgical emergency in our country. If not diagnosed and treated promptly, it can lead to extremely dangerous complications, threatening the patient's life.

1. What is pelvic appendicitis?

Pelvic appendicitis is one of the most common surgical emergencies in the abdominal emergency group (accounting for 60-65%), with many diverse clinical manifestations.
According to statistics, appendicitis can be encountered at any age, in places with favorable conditions for development, but appendicitis is quite rare in children < 3 years old, and Incidence increases with age, most commonly in adolescents.
The forms of appendicitis are usually relatively typical (that is, the common ones) are quite easy to diagnose and treat, the patient is operated on as soon as possible for good results, and no leave serious sequelae.
In the cases of atypical appendicitis, it is relatively difficult to diagnose because the clinical symptoms are extremely diverse, depending on the location of each patient, so it can be easily confused with other diseases, or even being missed, leading to untimely treatment and many other dangerous complications.

2. Causes of appendicitis of the pelvis

Various causes of appendicitis have been hypothesized and mechanisms underlying appendicitis have been established. The most common cause, recognized by many medical professionals, is appendicitis, which is caused by a blockage in the lumen of the appendix.
The main causes of obstruction are: hypertrophy of submucosal lymph cysts (60%), fecal stones (35%), tumors of the appendix or caecum (1%).

3. The role of ultrasound in the diagnosis of appendicitis in the pelvis

The technique of examining the ultrasound technique to assess the condition of the appendix was first mentioned by the author Puylaert J.B.C.M in 1986, since then, ultrasound technology has brought important contributions, playing a role. effective in the diagnosis and treatment of appendicitis.
In this technique, the specialist will use the high-frequency transducer to press the transducer area gradually, gently on the sensitive areas that the patient feels pain, suspected bowel. excess inflammation. From there, survey and accurately evaluate the swelling of the appendix being diagnosed with inflammation, so the ultrasound technique using slow transducer pressure will have three main purposes:
● Displace the interior of the small intestine and the loops of the small intestine away from the area under investigation.
● Approaching the appendix to achieve the optimal value is to examine the appendix in the beam localization of the transducer with high frequency.
● Assess for swelling of the entire inflamed appendix.
Ultrasound is considered a highly valuable method because it can detect appendicitis with a sensitivity of up to about 98.5%, a specificity of 98.2%, and a positive predictive value. counted as 98%. In addition, ultrasound also brings many values ​​in the diagnosis of other diseases causing pain in the right iliac fossa, especially gynecological or urological diseases. However, the limitation of ultrasonography is that it is difficult to accurately assess lesions in obese patients, who have excessive air in the intestinal loops.

4. Possible symptoms of appendicitis tiểu

4.1 Some functional symptoms ● The patient has abdominal pain in the right iliac fossa, in many cases it starts right in the epigastrium, or around the navel and then localizes in the right iliac fossa. The initial symptom is a dull and constant pain then the pain level will gradually increase over time. Patients rarely experience attacks of pain, and if they do, pain persists between attacks.
● Some patients may develop constipation.
● Vomiting or nausea , but not all cases are encountered.
4.2 Some physical symptoms ● The patient has a fever but not high, if high fever can be accompanied by extremely dangerous complications. but with children or the elderly quite discreet.
● Localized pain points include: Clado score, Lanz score, Mac-Burney score.
● Reaction in the right iliac fossa: this symptom plays a decisive role in diagnosis and treatment, it is necessary to conduct multiple follow-ups and compare 3 sides. This case needs special attention in elderly patients who are pregnant many times, so the abdominal wall is weak and difficult to detect.

5. Ultrasound diagnosis of appendicitis may be difficult in the following cases

● Patients with obesity make it difficult for ultrasound waves to penetrate deeply.
● The patient is suffering from small bowel obstruction or paralytic ileus, which is common in cases where it is slightly obscured, limiting visibility.
● Reactions in the abdominal wall, making it difficult to perform conventional ultrasound techniques (difficulty to compress the ultrasound probe in the vicinity of appendicitis).
● The patient's bladder is too distended, or because the patient is > 6 months pregnant, making it difficult to perform the compression technique.
● The position of the appendix is ​​relatively abnormal or the sonographer lacks professional experience.
Ultrasound diagnosis of appendicitis is a non-traumatic method and can be performed quickly and easily at nearly all reputable facilities, playing an important role in increasing the rate of pregnancy. Accurate diagnosis of appendicitis in patients with appendicitis. In addition, ultrasound also brings a lot of beneficial values ​​in diagnosing other diseases related to the gastrointestinal tract such as mesenteric lymphadenitis, gynecological diseases,...
Pelvic appendicitis if not Timely treatment can lead to many dangerous complications. As soon as the symptoms of the disease appear, you should immediately go to a reputable medical facility for examination and treatment.
Vinmec International General Hospital is a high-quality medical facility in Vietnam, equipped with facilities according to 5-star hotel standards, bringing comfort to patients during examination and treatment. The equipment is very modern, imported from the US, Japan, the Netherlands... to help diagnose and treat quickly and effectively. The doctors are all very dedicated, professional, highly qualified, trained from abroad, rich in experience.
Master, Doctor Luu Thi Bich Ngoc has 06 years of experience working in the field of diagnostic imaging, received formal training and graduated with a Master's degree from Hanoi Medical University. Dr. Ngoc has strengths in diagnosing breast, thyroid, liver cancers early. experience in doing ultrasound of tissue elastography for liver, breast, thyroid diseases... From 2019 until now, Dr. Ngoc has worked at Vinmec Times City International Hospital with a position at the department. Image analysation.

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