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Çocuklarda Akut Apandisit; Ultrasonografinin Tanısal Güvenilirliğinin Değerlendirilmesi

Year 2021, Volume: 15 Issue: 2, 123 - 128, 30.03.2021
https://doi.org/10.12956/tchd.674851

Abstract

Amaç: Akut apandisit pediatrik yaş grubunda zamanında teşhis edilmez ise perforasyon gibi önemli komplikasyonlar ile morbid seyredebilecek abdominal acillerin başında yer alır. Olgularının çoğunda doğru tanı konabilir. Ancak endişeli, huzursuz ve ağrısı olan bir çocukta semptomların seyrini saptamak oldukça zordur ve henüz iletişim becerileri iyi gelişmemiş küçük bir çocuğun yakınmalarını iyi ifade edemeyeceği de göz önüne alındığında, çocuklarda tanıyı koymak erişkinlere kıyasla daha zordur. Bu çalışmanın amacı pediatrik hastalarda akut apandisit tanısında abdominal ultrasonografinin (USG) doğruluğunu değerlendirmektir.
Gereç-Yöntem: 2012-2019 yılları arasında çocuk cerrahisi kliniğinde apandisit tanısı ile ameliyat edilen, 1-18 yaş arası ve ameliyattan önce USG yapılmış hastalar çalışmaya dahil edildi. Demografik göstergeler, tanı anındaki USG bulguları, ameliyat verileri ve patoloji raporları geriye dönük olarak değerlendirildi.
Bulgular: 203 (% 40) kız, 297 (% 60) erkek olmak üzere toplam 500 hasta değerlendirildi. Hastaların ortalama yaşı 10,1 ± 3,9 yıldı. Ameliyat öncesi USG verilerine göre; hastaların % 30’unda normal, %70’inde akut apandisit (bunlardan % 10’u perfore) şeklinde rapor yazılmıştı. Patolojik tanı açısından bakıldığında ise ameliyat edilen hastaların % 8inde normal apendiks dokusu (negatif apendektomi) tespit edilmişti. Bu çocuklarda USG’ nin duyarlılığı %71,96, özgüllüğü %48,78 ve doğruluğu %70,06 olarak tespit edildi. Pozitif ve negatif prediktif değerler ise sırasıyla % 94,03 ve % 13,42 olarak bulundu.
Tartışma: Elde edilen sonuçlara göre, çocuklarda akut apandisit tanısında USG, ucuz ve kolay uygulanabilen ancak güvenilirliği hala tartışmalara yol açabilecek bir test olarak değerlendirildi. USG’nin apandisit lehine raporlandığı hastalarda apandisit aleyhine raporlanmış olanlara göre tanı doğruluğunun daha yüksek olduğu bulundu. Ultrasonografik değerlendirmenin apandisit ile uyumlu olmadığı hastaların ise klinik bulgularının daha dikkatlice tekrar gözden geçirilmesi ve gerekirse ileri tetkik yapılması gerektiğini düşünüyoruz.

References

  • 1. Behzatolu B, Hatipoğlu E, Bayramoğlu S, Yılmaz G, Yirik G, Cimilli T. Akut Apandisit Tanısında Ultrasonografi ve Bilgisayarlı Tomografi Bulgularının Karşılaştırılması .MedicalJournal of Bakırköy, Volume 2, Number 1, 2006
  • 2. Yıldız T, İlçe Z, Turan G, Bozdağ Z, Elmas B. Parasites in the Etiology of Pediatric Appendicitis. TurkiyeParazitolDerg. 2015;39(3):190-3.
  • 3. Öztaş T, Dursun A, Söğütçü N, Bilici S. Unusual Histopathological Findings in Appendectomy Specimens Obtained from 1683 Pediatric Patients with Suspected Acute Appendicitis. Indian Journal of Surgery. 2018:1-6.
  • 4. Okoro KU, De La Espriella MG, Grider DJ, Baffoe-Bonnie AW. Tuberculous Enteritis Presenting as Acute Appendicitis and Perirectal Abscess. Case Rep Med. 2018;2018:6068258.
  • 5. Kılıc ŞS. Çocuklarda apandisit. Med J SDU / SDÜ Tıp Fak Derg 2015:Çocuk Özel Sayısı:12-16
  • 6. Almaramhy HH. Acute appendicitis in young children less than 5 years: review article. Ital J Pediatr. 2017;43(1):15.
  • 7. Kaiser S, Jorulf H, Söderman E, Frenckner B. Impact of radiologic imaging on the surgical decisionmaking process in suspected appendicitis in children. AcadRadiol. 2004;11(9):971-9.
  • 8. Bachur RG, Dayan PS, Bajaj L, Macias CG, Mittal MK, Stevenson MD, et al. The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis. Ann Emerg Med. 2012;60(5):582-590.e3.
  • 9. Erikci VS. Management of Pediatric Appendicitis. Current Issues in the Diagnostics and Treatment of Acute Appendicitis: IntechOpen; 2018.
  • 10. Alireza Pedram1, Fatemeh Asadian2*, Naghmeh Roshan3. Diagnostic Accuracy of Abdominal Ultrasonography in pediatric Acute Appendicitis. BullEmergTrauma2019;7(3):278-283.
  • 11. Sauvain MO, Slankamenac K, Muller MK, Wildi S, Metzger U, Schmid W, et al. Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications. Langenbecks Arch Surg. 2016;401(5):643-9.
  • 12. Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, et al. Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature. Crit Ultrasound J. 2013;5Suppl 1:S2.
  • 13. Alvarado A. Clinical Approach in the Diagnosis of Acute Appendicitis. Current Issues in the Diagnostics and Treatment of Acute Appendicitis: IntechOpen; 2018.
  • 14. Nielsen JW, Boomer L, Kurtovic K, Lee E, Kupzyk K, Mallory R, et al. Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. J Pediatr Surg. 2015;50(1):144-8.
  • 15. Sauvain MO, Slankamenac K, Muller MK, Wildi S, Metzger U, Schmid W, et al. Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperativecomplications. Langenbecks Arch Surg. 2016;401(5):643-9.
  • 16. Boonstra PA, van Veen RN, Stockmann HB. Less negative appendectomies due to imaging in patients with suspected appendicitis. SurgEndosc. 2015;29(8):2365-70.
  • 17. Marzouni HZ, Davachi B, Rezazadeh M, Milani MS, Matinfard S. Diagnostic Value of Hepatic Vein Ultrasound in Early Detection of Liver Cirrhosis. Galen Medical Journal. 2018;7:1140.
  • 18. Abu-Yousef MM, Bleicher JJ, Maher JW, Urdaneta LF, Franken Jr E, Metcalf A. High-resolution sonography of acute appendicitis. American Journal of Roentgenology. 1987;149(1):53-8.
  • 19. Chen SC, Wang HP, Hsu HY, Huang PM, Lin FY. Accuracy of ED sonography in the diagnosis of acute appendicitis. Am J Emerg Med. 2000;18(4):449-52.
  • 20. . Lessin MS, Chan M, Catallozzi M, Gilchrist MF, Richards C, Manera L, et al. Selective use of ultrasonography for acute appendicitis in children. Am J Surg. 1999;177(3):193-6.
  • 21. Ramachandran P, Sivit CJ, Newman KD, Schwartz MZ. Ultrasonography as an adjunct in the diagnosis of acute appendicitis: a 4-year experience. J Pediatr Surg. 1996;31(1):164-7; discussion 167-9.
  • 22. Marusch F, Allecke K, Gastinger I. Value of ultrasound in diagnosis of appendicitis. Results of the East German Multicenter Study. East German Working Group “Outcome Assessment and Quality Assurance in Surgery” of the CAQ of the GermanSociety of Surgery. ZentralblChir. 1998;123Suppl 4:29-31.
  • 23. Günşar C, Karaca I, Ceylan H, Etensel B, Şencan A, Çetin G.G., Kızılay N, Mir E. Çocukluk çağı akut ve perfore apandisitlerinde ultrasonografik bulguların tanı değerleri. Akademik gastroenteroloji dergisi, 2004; 3 (2): 88-92
  • 24. Hahn HB, Hoepner FU, Kalle T, Macdonald EB, Prantl F, Spitzer IM, et al. Sonography of acute appendicitis in children: 7 years experience. PediatrRadiol. 1998;28(3):147-51.
  • 25. Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston textbook of surgery E-book: Elsevier Health Sciences; 2012
  • 26. Heller MT, Hattoum A. Imaging of acute right lower quadrant abdominal pain: differential diagnoses beyond appendicitis. EmergRadiol. 2012;19(1):61-73.
Year 2021, Volume: 15 Issue: 2, 123 - 128, 30.03.2021
https://doi.org/10.12956/tchd.674851

Abstract

References

  • 1. Behzatolu B, Hatipoğlu E, Bayramoğlu S, Yılmaz G, Yirik G, Cimilli T. Akut Apandisit Tanısında Ultrasonografi ve Bilgisayarlı Tomografi Bulgularının Karşılaştırılması .MedicalJournal of Bakırköy, Volume 2, Number 1, 2006
  • 2. Yıldız T, İlçe Z, Turan G, Bozdağ Z, Elmas B. Parasites in the Etiology of Pediatric Appendicitis. TurkiyeParazitolDerg. 2015;39(3):190-3.
  • 3. Öztaş T, Dursun A, Söğütçü N, Bilici S. Unusual Histopathological Findings in Appendectomy Specimens Obtained from 1683 Pediatric Patients with Suspected Acute Appendicitis. Indian Journal of Surgery. 2018:1-6.
  • 4. Okoro KU, De La Espriella MG, Grider DJ, Baffoe-Bonnie AW. Tuberculous Enteritis Presenting as Acute Appendicitis and Perirectal Abscess. Case Rep Med. 2018;2018:6068258.
  • 5. Kılıc ŞS. Çocuklarda apandisit. Med J SDU / SDÜ Tıp Fak Derg 2015:Çocuk Özel Sayısı:12-16
  • 6. Almaramhy HH. Acute appendicitis in young children less than 5 years: review article. Ital J Pediatr. 2017;43(1):15.
  • 7. Kaiser S, Jorulf H, Söderman E, Frenckner B. Impact of radiologic imaging on the surgical decisionmaking process in suspected appendicitis in children. AcadRadiol. 2004;11(9):971-9.
  • 8. Bachur RG, Dayan PS, Bajaj L, Macias CG, Mittal MK, Stevenson MD, et al. The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis. Ann Emerg Med. 2012;60(5):582-590.e3.
  • 9. Erikci VS. Management of Pediatric Appendicitis. Current Issues in the Diagnostics and Treatment of Acute Appendicitis: IntechOpen; 2018.
  • 10. Alireza Pedram1, Fatemeh Asadian2*, Naghmeh Roshan3. Diagnostic Accuracy of Abdominal Ultrasonography in pediatric Acute Appendicitis. BullEmergTrauma2019;7(3):278-283.
  • 11. Sauvain MO, Slankamenac K, Muller MK, Wildi S, Metzger U, Schmid W, et al. Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications. Langenbecks Arch Surg. 2016;401(5):643-9.
  • 12. Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, et al. Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature. Crit Ultrasound J. 2013;5Suppl 1:S2.
  • 13. Alvarado A. Clinical Approach in the Diagnosis of Acute Appendicitis. Current Issues in the Diagnostics and Treatment of Acute Appendicitis: IntechOpen; 2018.
  • 14. Nielsen JW, Boomer L, Kurtovic K, Lee E, Kupzyk K, Mallory R, et al. Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. J Pediatr Surg. 2015;50(1):144-8.
  • 15. Sauvain MO, Slankamenac K, Muller MK, Wildi S, Metzger U, Schmid W, et al. Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperativecomplications. Langenbecks Arch Surg. 2016;401(5):643-9.
  • 16. Boonstra PA, van Veen RN, Stockmann HB. Less negative appendectomies due to imaging in patients with suspected appendicitis. SurgEndosc. 2015;29(8):2365-70.
  • 17. Marzouni HZ, Davachi B, Rezazadeh M, Milani MS, Matinfard S. Diagnostic Value of Hepatic Vein Ultrasound in Early Detection of Liver Cirrhosis. Galen Medical Journal. 2018;7:1140.
  • 18. Abu-Yousef MM, Bleicher JJ, Maher JW, Urdaneta LF, Franken Jr E, Metcalf A. High-resolution sonography of acute appendicitis. American Journal of Roentgenology. 1987;149(1):53-8.
  • 19. Chen SC, Wang HP, Hsu HY, Huang PM, Lin FY. Accuracy of ED sonography in the diagnosis of acute appendicitis. Am J Emerg Med. 2000;18(4):449-52.
  • 20. . Lessin MS, Chan M, Catallozzi M, Gilchrist MF, Richards C, Manera L, et al. Selective use of ultrasonography for acute appendicitis in children. Am J Surg. 1999;177(3):193-6.
  • 21. Ramachandran P, Sivit CJ, Newman KD, Schwartz MZ. Ultrasonography as an adjunct in the diagnosis of acute appendicitis: a 4-year experience. J Pediatr Surg. 1996;31(1):164-7; discussion 167-9.
  • 22. Marusch F, Allecke K, Gastinger I. Value of ultrasound in diagnosis of appendicitis. Results of the East German Multicenter Study. East German Working Group “Outcome Assessment and Quality Assurance in Surgery” of the CAQ of the GermanSociety of Surgery. ZentralblChir. 1998;123Suppl 4:29-31.
  • 23. Günşar C, Karaca I, Ceylan H, Etensel B, Şencan A, Çetin G.G., Kızılay N, Mir E. Çocukluk çağı akut ve perfore apandisitlerinde ultrasonografik bulguların tanı değerleri. Akademik gastroenteroloji dergisi, 2004; 3 (2): 88-92
  • 24. Hahn HB, Hoepner FU, Kalle T, Macdonald EB, Prantl F, Spitzer IM, et al. Sonography of acute appendicitis in children: 7 years experience. PediatrRadiol. 1998;28(3):147-51.
  • 25. Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston textbook of surgery E-book: Elsevier Health Sciences; 2012
  • 26. Heller MT, Hattoum A. Imaging of acute right lower quadrant abdominal pain: differential diagnoses beyond appendicitis. EmergRadiol. 2012;19(1):61-73.
There are 26 citations in total.

Details

Primary Language Turkish
Subjects Surgery
Journal Section ORIGINAL ARTICLES
Authors

Hasan Özkan Gezer 0000-0002-4635-2613

Abdulkerim Temiz 0000-0001-8789-6003

Semire Serin Ezer 0000-0002-9597-3264

Emine İnce 0000-0002-2120-1958

Şenay Demir Kekeç 0000-0002-4209-9075

Bermal Hasbay 0000-0002-7941-7962

Publication Date March 30, 2021
Submission Date January 14, 2020
Published in Issue Year 2021 Volume: 15 Issue: 2

Cite

Vancouver Gezer HÖ, Temiz A, Ezer SS, İnce E, Demir Kekeç Ş, Hasbay B. Çocuklarda Akut Apandisit; Ultrasonografinin Tanısal Güvenilirliğinin Değerlendirilmesi. Türkiye Çocuk Hast Derg. 2021;15(2):123-8.


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