Cause of Abdominal Ultrasound Diagnostic Errors in Children with Acute Appendicitis

Yoo Mi Kim; Jae Hee Chung

doi:10.13029/jkaps.2016.22.2.33

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Kim and Chung: Cause of Abdominal Ultrasound Diagnostic Errors in Children with Acute Appendicitis

Original Article

Journal of the Korean Association of Pediatric Surgeons 2016; 22(2): 33-37.

Published online: 22 December 2016

DOI: https://doi.org/10.13029/jkaps.2016.22.2.33

Cause of Abdominal Ultrasound Diagnostic Errors in Children with Acute Appendicitis

Yoo Mi Kim, Jae Hee Chung

Department of Surgery, Yeouido St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea.

Correspondence: Jae Hee Chung, Department of Surgery, Yeouido St. Mary's Hospital, School of Medicine, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea. Tel: +82-2-3779-1040, Fax: +82-2-786-0802, jhjung@catholic.ac.kr

Received 13 June 2016 Revised 12 September 2016 Accepted 11 October 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The use of CT as a diagnostic tool in pediatric acute appendicitis is increasing because of its high sensitivity and specificity. However, due to both the serious concerns about radiation of CT and the convenience and reasonable cost of ultrasound (US) examination, US has value on the initial diagnosis of acute appendicitis despite of the lower sensitivity in children. The purpose of this study was to examine the factors that affect the rate of false negative diagnosis of the ultrasound from the patients who received laparoscopic appendectomy.

Methods

The pediatric appendectomy cases from 2002 to 2013 in Yeouido St. Mary's Hospital have been reviewed through the medical records. We included patients who underwent an initial screening by ultrasound examination.

Results

Among 181 patients, 156 patients were the sono-positive group and 25 patients were sono-negative group. There is no significant difference in ages, genders, physical examination findings and white blood cell count between the two groups. But, the degree of inflammation of appendicitis (simple, 58.3% vs. 32.0%; complicated, 41.7% vs. 68.0%) and the appendix position (antececal, 85.0% vs. 12.0%; retrocecal, 13.7% vs. 44.0%; pelvic, 1.3% vs. 44.0%) were significantly different between the two groups (sono-positive group vs. sono-negative group; p<0.05).

Conclusion

The position of the appendix may act as a factor that causes an error in the diagnostic ultrasound, especially, in the retrocecal type and the pelvic type with the higher risk of necrosis or perforation.

Keywords: Appendicitis, Ultrasonography, Diagnostic errors

Figures and Tables

Table 1

Characteristics of Patients Who Received Appendectomy with Acute Appendicitis (n=181)

Values are presented as mean±SD or n (%).

Seg., segmented; exam., examination; RLQ, right lower quadrant; DT, direct tenderness; RT, rebound tenderness; MG, muscle guarding.

Table 2

Characteristics of Patients with Negative Ultrasonographic Finding (n=25)

Notes

^{CONFLICTS OF INTEREST} No potential conflict of interest relevant to this article was reported.

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