Oktay Cemil, Goksu Mehmet, Yavuz Sibel
Department of Radiology, Adiyaman University Training and Research Hospital, Adiyaman, Turkiye.
Department of Pediatric Surgery, Adiyaman University Faculty of Medicine, Adiyaman, Turkiye.
North Clin Istanb. 2023 Sep 14;10(5):631-635. doi: 10.14744/nci.2022.67984. eCollection 2023.
Appendicitis typically develops secondary to obstruction of appendiceal lumen and one of the causes of obstruction is appendicolith. Appendicolith has become a relevant issue due to heightened interest in the treatment of uncomplicated appendicitis with antibiotics. This study aimed to determine the prevalence of appendicolith in pediatric patients with appendicitis and to investigate the association between the presence of appendicoliths and radiological disease severity.
Patients under the age of 18 diagnosed with appendicitis between March 2021 and April 2022 and had available preoperative computed tomography (CT) images were identified retrospectively. The presence of an appendicolith and if present, its longest diameter in the axial plane, its visibility on direct radiographs, appendiceal diameter, degree of inflammation, and the presence of perforation were evaluated. Radiological severity of inflammation was rated on a 3-point scale.
CT scans were available in 77 (32.1%) of 240 patients with histopathologically confirmed diagnosis of acute appendicitis. 39% (n=30) of the patients were girls and the median age was 13 years. The prevalence of appendicoliths detected on CT scans was 32.5% (n=25) and the median size of appendicoliths was 6 mm. In only 1 patient, appendicolith was detected by direct radiography. The median appendiceal diameter was significantly greater in the group with appendicoliths (10 mm vs. 8 mm; p=0.001). A moderate correlation was found between appendicolith size and appendiceal diameter (r=0.407, p=0.043). Perforation was present in 10.4% (n=8) of the patients with appendicitis and 25% (n=2) of them had appendicoliths. The presence of appendicoliths was not significantly associated with the occurrence of perforation (p=0.485). Periappendiceal inflammation scores were 1.52±0.74 in the group with appendicoliths and 1.42±0.63 in the group without appendicoliths (p=0.591).
The prevalence of CT-detected appendicoliths was 32.5% in pediatric patients with appendicitis. Patients with appendicoliths showed higher inflammation scores and greater appendiceal diameter than those without appendicoliths. These factors may be associated with poor outcomes in patients with appendicoliths treated with antibiotics. Therefore, knowledge of the prevalence of appendicoliths and questioning their presence may guide clinicians when deciding on the suitability of nonoperative treatment in a patient diagnosed with uncomplicated acute appendicitis.
阑尾炎通常继发于阑尾腔梗阻，而梗阻的原因之一是阑尾粪石。由于对单纯性阑尾炎采用抗生素治疗的关注度提高，阑尾粪石已成为一个相关问题。本研究旨在确定小儿阑尾炎患者中阑尾粪石的患病率，并调查阑尾粪石的存在与放射学疾病严重程度之间的关联。
回顾性确定2021年3月至2022年4月期间诊断为阑尾炎且有术前计算机断层扫描（CT）图像的18岁以下患者。评估阑尾粪石的存在情况，若存在，评估其在轴位平面的最长直径、在直接X线片上的可见性、阑尾直径、炎症程度以及穿孔情况。炎症的放射学严重程度按3分制评分。
240例经组织病理学确诊为急性阑尾炎的患者中，77例（32.1%）有CT扫描结果。39%（n = 30）的患者为女孩，中位年龄为13岁。CT扫描检测到的阑尾粪石患病率为32.5%（n = 25），阑尾粪石的中位大小为6mm。仅1例患者通过直接X线片检测到阑尾粪石。有阑尾粪石组的阑尾中位直径显著大于无阑尾粪石组（10mm对8mm；p = 0.001）。发现阑尾粪石大小与阑尾直径之间存在中度相关性（r = 0.407，p = 0.043）。阑尾炎患者中有10.4%（n = 8）存在穿孔，其中25%（n = 2）有阑尾粪石。阑尾粪石的存在与穿孔的发生无显著相关性（p = 0.485）。有阑尾粪石组的阑尾周围炎症评分为1.52±0.74，无阑尾粪石组为1.42±0.63（p = 0.591）。
小儿阑尾炎患者中CT检测到的阑尾粪石患病率为32.5%。有阑尾粪石的患者比无阑尾粪石的患者炎症评分更高，阑尾直径更大。这些因素可能与用抗生素治疗的有阑尾粪石患者的不良预后相关。因此，了解阑尾粪石的患病率并询问其是否存在，可能会在临床医生决定对诊断为单纯性急性阑尾炎的患者进行非手术治疗的适用性时提供指导。
