Nah Shireen Anne, Ong Sophie Sihui, Lim Wei Xiang, Amuddhu Sanjena Kumar, Tang Phua Hwee, Low Yee
Pediatric Surgery, KK Women's and Children's Hospital, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Pediatr. 2017 Mar;182:164-169.e1. doi: 10.1016/j.jpeds.2016.11.062. Epub 2016 Dec 21.
To evaluate the clinical relevance of the nonvisualized appendix on ultrasound imaging in children with right lower quadrant pain.
We reviewed 1359 children admitted for abdominal pain between January and December 2013 who had abdominal ultrasound imaging for right lower quadrant pain. Patients who had scans for genitourinary symptoms or intussusception were excluded from the study. When the appendix was not visualized, secondary signs indicating right lower quadrant inflammatory pathology were noted.
Of all admissions for abdominal pain, 810 had ultrasound scans. Thirty-eight did not evaluate the appendix and 131 were excluded for suspected intussusception, leaving 641 reports for children with a median age of 10.8 years (range, 1.3-21.3); 297 were boys (46.3%). There were 17 of 160 patients with a nonvisualized appendix (10.6%) who underwent appendectomy. Of these, 14 had secondary signs on ultrasound imaging and 3 (1.9%) had normal ultrasound reports. The 3 patients with normal ultrasound imaging had computed tomography imaging confirming appendicitis. There were 51 patients with a partially visualized appendix. The segment of appendix that could be seen was normal in 34 patients, none of whom had appendectomy. The remaining 17 had appendectomy, in whom the appendix seemed to be inflamed in 13 and equivocal in 4, all with histologically confirmed appendicitis. Overall, 232 children underwent appendectomy; 58 had no ultrasound imaging done, and 5 had a histologically normal appendix (overall negative appendectomy rate, 2.2%). Only 35 of 1359 patients (0.03%) had computed tomography scans.
In patients with a nonvisualized appendix on ultrasound imaging and no evidence of secondary inflammatory changes, the likelihood of appendicitis is less than 2%. Generous use of ultrasonography as an adjunct to clinical examination can achieve low negative appendectomy rates without underdiagnosis of acute appendicitis.
评估超声检查未显示阑尾在右下腹痛儿童中的临床相关性。
我们回顾了2013年1月至12月因腹痛入院且因右下腹痛接受腹部超声检查的1359名儿童。因泌尿生殖系统症状或肠套叠进行扫描的患者被排除在研究之外。当阑尾未显示时，记录提示右下象限炎症性病变的次要征象。
在所有因腹痛入院的患者中，810人进行了超声扫描。38人未评估阑尾，131人因疑似肠套叠被排除，剩下641份报告，儿童中位年龄为10.8岁（范围1.3 - 21.3岁）；297人为男孩（46.3%）。160例阑尾未显示的患者中有17例（10.6%）接受了阑尾切除术。其中，14例超声检查有次要征象，3例（1.9%）超声报告正常。3例超声检查正常的患者经计算机断层扫描成像确诊为阑尾炎。51例患者阑尾部分显示。34例可见的阑尾节段正常，这些患者均未接受阑尾切除术。其余17例接受了阑尾切除术，其中13例阑尾似乎发炎，4例情况不明确，所有病例经组织学确诊为阑尾炎。总体而言，232名儿童接受了阑尾切除术；58人未进行超声检查，5人阑尾组织学正常（总体阴性阑尾切除率为2.2%）。1359例患者中只有35例（0.03%）进行了计算机断层扫描。
超声检查阑尾未显示且无继发性炎症改变证据的患者，患阑尾炎的可能性小于2%。广泛使用超声作为临床检查的辅助手段可实现低阴性阑尾切除率，且不会漏诊急性阑尾炎。
