Bedside Sonographic Characteristics of Early and Late Appendicitis

Jung,  Sung Min; Jeon,  Hyun Min; Hong,  Chong Kun; Shin,  Tae Yong; Ha,  Young Rock; Kim,  Young Sik; Paik,  So Ya

J Korean Soc Emerg Med > Volume 24(5); 2013 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2013;24(5): 539-547.

Bedside Sonographic Characteristics of Early and Late Appendicitis

Sung Min Jung, Hyun Min Jeon, Chong Kun Hong, Tae Yong Shin, Young Rock Ha, Young Sik Kim, So Ya Paik

¹Department of Emergency Medicine, Daejin Medical Center, Bundang Jesaeng General Hospital, Bundang-si, Gyeonggi-do, South Korea. youngrock.ha@gmail.com
²Department of Pathology, Daejin Medical Center, Bundang Jesaeng General Hospital, Bundang-si, Gyeonggi-do, South Korea.

ABSTRACT

PURPOSE:
Studies on the relationship between appendiceal inflammation and bedside ultrasonographic findings are lacking. The purpose of this study was to determine statistically significant parameters to diagnose appendicitis earlier by comparing ultrasonographic findings and clinical features between early and late appendicitis.
METHODS:
A registry of right lower quadrant (RLQ) pain ultrasound from December 2011 to December 2012 was reviewed. Among these cohorts, patients pathologically proven to have appendicitis were selected and divided into two groups: an early appendicitis group, patients who complained of a diffuse abdominal pain, and a late appendicitis group, patients who complained of a localized right lower quadrant pain. The two groups were compared according to gender, age, bedside ultrasonographic findings, inflammatory markers, clinical features, and postoperative pathological findings.
RESULTS:
A total of 102 patients were enrolled in this study. Among them, 42 patients (41.2%) were in the early appendicitis group and 60(58.8%) were in the late appendicitis group. Appendiceal diameter and noncompressibility did not differ between the groups. However, periappendiceal fat infiltration and fluid were less prevalent in the early group (p=0.031 vs. p=0.022, respectively).
CONCLUSION:
Appendiceal diameter and non-compressibility were the only bedside ultrasound findings found in early appendicitis patients. Emergency physicians can detect early appendicitis and prevent complications before the migration of abdominal pain to the RLQ by bedside ultrasonography.

Key words: Appendicitis, Ultrasonography, Right lower quadrant pain