Ultrasound Differentiates Complicated, Uncomplicated Appendicitis

Appendiceal sonograms may help clinicians tell which patients have uncomplicated versus complicated appendicitis.

Ultrasound images may help clinicians differentiate between complicated and uncomplicated appendicitis among patients with known appendicitis, according to a study published in the Journal of Ultrasound in Medicine.

Researchers from Stanford University School of Medicine in California performed a retrospective study to evaluate the use of ultrasound as an indicator of complicated versus uncomplicated appendicitis in known appendicitis.

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. The researchers compared 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.

The results showed that 32 of the 119 patients (26.9%) had complicated appendicitis; 11 of the 32 had gangrenous appendicitis without perforation and 21 had gangrenous appendicitis and perforation. Loss of the submucosal layer was the only independent significant indicator of complicated appendicitis in multivariate regression and provided sensitivity and specificity values of 100.0% and 92.0%, respectively.

The researchers concluded that sonographic images allowed clinicians to visualize loss of the normally echogenic submucosal layer, which was the most useful finding for discriminating complicated from uncomplicated appendicitis, and the only finding independently and significantly associated with complicated appendicitis. This information may help a physician decide whether to proceed with antibiotic therapy or with appendectomy.