value of color doppler in the evaluation of suspected appendicitis

ABSTRACT

Acute appendicitis is the commonest surgical abdominal emergency. The optimal management of acute appendicitis is predicated on early diagnosis and prompt operative intervention. The early clinical diagnosis of this condition remains difficult, as approximately one third of patients with the disease have an uncertain preoperative diagnosis. This may lead to a delay in surgery or to unnecessary laparoscopy. The consequences of missed or delayed diagnosis include perforation, abscess formation and peritonitis. These complications can result in longer hospitalization and increased risk of infertility in female patients. Another challenge in the management of acute right lower quadrant pain is to reduce the frequency of negative laparoscopies. The percentage of normal appendices at laparotomy in various studies has ranged as high as 25% .Current imaging modalities utilized in the assessment of suspected appendicitis include radiography, sonography and CT. The principal imaging technique utilized at many institutions is sonography. Sonographic diagnosis of the inflamed appendix is well known, but what color Doppler can add in its accuracy. Sonography can not alone diagnose non-obstructive appendicitis, can color Doppler help in this situation. What is the relation between the pattern of vascularity and the degree of inflammation? To the best of our knowledge no detectable studies in the literature about the color Doppler features of different inflammatory types and degrees of appendicitis. We performed color Doppler imaging in patients with suspected appendicitis to characterize its ability to differentiate acute obstructive from non obstructive appendicitis, appendiceal perforation from appendiceal abscesses. Fifty patients with surgically proven appendicitis were selected for the results out of eighty nine patients examined by color Doppler to assess the vascularity of the inflamed appendix. Vascularity was considered diffuse when the vessels were evenly distributed around the walls of the inflamed appendix, while it was considered patchy in uneven increased vascularity. Fifty patients with surgically proven appendicitis were selected for the results out of eighty nine patients examined by color Doppler. The patients were 37 female and 13 male with average age of 23 years. Patients with appendicitis were divided into five groups. Group A include twenty one cases with obstructed non perforated appendicitis, group B include six patients with non-Obstructed non perforated appendicitis, group C include seven patients with Impending perforation, group D include ten patients with perforated appendicitis and group E include six patients with appendicular abscess. Color Doppler sonography showed appendicular hyper-vascularity in 18 of the 21 patients with Obstructed non-perforating appendicitis group [A] and in 4 of the 10 patients with perforating appendicitis group [D] While in 2 of the 6 patients with appendicular abscess group [E] The hyper - vascularity was patchy in 14 of group [A]and in 5 of group [C]and in 3 of group D. Diffuse hyper-vascularity was noted in four cases with group [A]. while in one case out of 10 in group [D]and no detectable diffuse hyper- vascularity in appendicular abscess cases, while all cases in group [B] had diffuse even hyper-vascularity. Color Doppler can show the type of vascularity of the inflamed appendix and so the level of its