The Usefulness of Combined B Mode and Doppler Ultrasonography to Guide Treatment of Appendicitis

Abstract

Introduction We have succeeded in classifying the severity of appendicitis by evaluating the structure of the submucosal layer and blood flow in the appendix wall with ultrasonography (US). Here, we propose a new preoperative classification system to guide treatment strategy.

Materials and Methods Between February 2005 and December 2011, a total of 440 acute appendicitis cases were diagnosed, and 407 met inclusion criteria for this study. US and Doppler findings were used to classify cases as Grade I, IIa, IIb, III, or appendiceal mass. Grades I and IIa were treated conservatively without antibiotics. Appendectomy for Grades IIb and III and interval appendectomy for appendiceal mass were performed.

Results Of 407 cases, 38 were Grade I, 132 were Grade IIa, 130 were Grade IIb, 57 were Grade III, and 50 were appendiceal mass. Improvement occurred without antibiotics in 37 (97.3%) Grade I and 129 (97.7%) Grade IIa cases. Recurrence occurred postdischarge in 9 (23.6%) Grade I and 35 (26.5%) Grade IIa cases. All Grades IIb and III patients had gangrenous or phlegmonous appendicitis. There were no negative appendectomies.

Conclusion Even if US findings reveal swelling or an irregular submucosal layer, when power Doppler identifies abundant blood flow, inflammation may improve spontaneously. Decreased appendiceal wall blood flow indicates irreversible necrotic change. Doppler and B-mode US used together improve acute appendicitis treatment.

Keywords

acute appendicitis - ultrasound - power Doppler ultrasonography

• References

• 1 Shibasaki S, Takahashi N, Homma S , et al. Use of transabdominal ultrasonography to preoperatively determine T-stage of proven colon cancers. Abdom Imaging 2015; 40 (6) 1441-1450
• 2 Spear R, Kimmey MB, Wang KY, Sillery JK, Benjamin DR, Sawin RS. Appendiceal US scans: histologic correlation. Radiology 1992; 183 (3) 831-834
• 3 Kaneko K, Tsuda M. Ultrasound-based decision making in the treatment of acute appendicitis in children. J Pediatr Surg 2004; 39 (9) 1316-1320
• 4 Quillin SP, Siegel MJ. Appendicitis: efficacy of color Doppler sonography. Radiology 1994; 191 (2) 557-560
• 5 Patriquin HB, Garcier JM, Lafortune M , et al. Appendicitis in children and young adults: Doppler sonographic-pathologic correlation. AJR Am J Roentgenol 1996; 166 (3) 629-633
• 6 Migraine S, Atri M, Bret PM, Lough JO, Hinchey JE. Spontaneously resolving acute appendicitis: clinical and sonographic documentation. Radiology 1997; 205 (1) 55-58
• 7 Mason RJ. Surgery for appendicitis: is it necessary?. Surg Infect (Larchmt) 2008; 9 (4) 481-488
• 8 Abeş M, Petik B, Kazil S. Nonoperative treatment of acute appendicitis in children. J Pediatr Surg 2007; 42 (8) 1439-1442
• 9 Varadhan KK, Humes DJ, Neal KR, Lobo DN. Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis. World J Surg 2010; 34 (2) 199-209
• 10 Svensson JF, Hall NJ, Eaton S, Pierro A, Wester T. A review of conservative treatment of acute appendicitis. Eur J Pediatr Surg 2012; 22 (3) 185-194
• 11 Cobben LP, de Van Otterloo AM, Puylaert JB. Spontaneously resolving appendicitis: frequency and natural history in 60 patients. Radiology 2000; 215 (2) 349-352
• 12 Tsai HM, Shan YS, Lin PW, Lin XZ, Chen CY. Clinical analysis of the predictive factors for recurrent appendicitis after initial nonoperative treatment of perforated appendicitis. Am J Surg 2006; 192 (3) 311-316
• 13 Lien WC, Lee WC, Wang HP, Chen YC, Liu KL, Chen CJ. Male gender is a risk factor for recurrent appendicitis following nonoperative treatment. World J Surg 2011; 35 (7) 1636-1642
• 14 Sgourakis G, Sotiropoulos GC, Molmenti EP , et al. Are acute exacerbations of chronic inflammatory appendicitis triggered by coprostasis and/or coproliths?. World J Gastroenterol 2008; 14 (20) 3179-3182