The Role of Sonographic Imaging in Acute Appendicitis in Khartoum Teaching Hospitals

Abstract

Objectives: To describe Sudanese experience in using ultrasound and Doppler ultrasound in diagnosis of acute appendicitis, incorporating Alvarado score. Materials and Method: Design: A randomized sample of patients suspected of acute appendicitis on clinical grounds,were scanned sonographically and the clinical findings were matched with Alvarado score. Settings: Patients were collected from Khartoum Teaching Hospital and Fedail Medical Center for scanning the patients. Participants: Sixty one patients (aged 7 – 60 years) seen in the surgical department suspected of appendicitis. Thirty-five males (57.4%) and 26 females (42.6%) all underwent ultrasonography. Methods: High frequency transducer was used, employing graded compression and Doppler technique. Results The typical inflammed, enlarged appendix with diameter of >6mm,and non-compressible was seen in most of the positive cases. Six patients (9.8%) had hypoechoic, fluid filled appendix.. Five patients (8.2%) had loculated pericecal fluid collection. Three patients (4.9 %) with echogenic mucosa and fluid filled appendix.. Nine patients (14.5%) had appendicolith. Seven patients (11.3%) had creeping fat sign. One patient had free intraperitoneal fluid as complication of perforation. Of the forty three conditions of acute appendicitis, sonography was able to precisely determine the position of the appendix twenty nine conditions (67.4%) being retrocecal in ten patients (23. %), pelvic in five patients(11.6%), preileal in two patients (4.8%), post ileal in four patients (9.3%), retrocecal subhepatic in two patients (4.8%)and paracecal in five patients (11.6%).On three conditions only, ultrasound has failed to determine the position of the appendix , it was only revealed by operative findings, and they were subcecal in position. There was increased Doppler activity in 37 patients (86. %) with inflamed appendix.. Twenty-six patients (70.2%) were with score of 5 on Alvarado scale, followed by five patients (13.5% )with the score of 7,four patients (10.8%) with the score of 6,and two patients (5.4%)with the score of 4. Alvarado score, 4 , 5 , 6 lie under the normal distribution curve ,they represent the equivocal cases who could benefit from sonography, while the extremes 3 and 8 could either be for observation and operative management respectively. The sensitivity was 97% and specificity 100% in this study. The accuracy of Doppler ultrasound was 70.5%. Conclusion: This study has expressed a Sudanese experience in the sonographic imaging of acute appendicitis. It has confirmed the usefulness of ultrasonography as an additional diagnostic tool in appendicitis with high confidence. Meticulous scanning, graded compression and Doppler ultrasound are invaluable adjunct tool in locating the position of the inflamed appendix, and for decision making in equivocal cases with Alvarado score,4,5,6.