Predicting of histopathologic type of acute appendicitis by ultrasound: a prospective study of 70 cases

Abstract

Purpose: To evaluate the value of ultrasound in preoperative predicting of histopathological diagnosis of acute appendicitis. Material and methods: Prospectively 70 patients operated and histopathologicaly confirmed with diagnosis of appendicitis were evaluated. Males were 34 and females 36 with mean age of 19 years (rang 14-64 years). Ultrasound technique with graded compression was used for examination of ileocecal region. Criteria for appendicitis were: direct visualization of appendix vermiformis, diameter more than 5 mm, incompressibility, clear visualization of the wall’s layers, presence of periapendicular inflamed fat tissue and local presence of small free fluid. Results: Catharal appendicitis was present in 10 (14.3%) cases, phlegmonous appendicitis was present in 18 (25.7%) cases, gangrenous without perforation histologicaly was diagnosed in 16 (22.9%) cases, whereas gangrenous perforated appendicitis was present in 11 (15.7%) cases. Appendicular abscess had 6 (8.6%) cases and abortive appendicitis 9 (12.9%) cases. Correlation between histopathology and preoperative ultrasound diagnosis was found in 90% of the cases. Operative finding in 87% of the cases correlated with histopathological finding. Sensitivity and specificity of ultrasonography for histopathological diagnosing of gangrenous appendicitis without perforation is the lowest, whereas for phlegmonous appendicitis is the highest. Conclusion: Ultrasound is valuable method for preoperative predicting of histopathological type of acute appendicitis.