Akut Apandisit Şüphesi Olan Hastaların Karın Ağrısı Ayırıcı Tanısında Bilgisayarlı Tomografinin Yeri

Yıl 2019, Cilt: 2 Sayı: 3, 17 - 20, 30.09.2019

Huseyin Cetin Arslan Turgay Yilmaz Kilic Hasan Idil Tuna Imamoglu Murat Yesilaras

Öz

Amaçlar: Akut apandisit tanısı çoğu zaman klinik değerlendirme ve ultrasonografi (USG) ile koyulur. Karın ağrısı nedenlerini netleştirmek için ileri görüntüleme olarak sıklıkla bilgisayarlı tomografi (BT) tercih edilir. Bu çalışmada akut apandisit şüphesi olan olgularda BT'nin tanısal etkinliği araştırıldı.

Yöntemler: Acil servise karın ağrısı şikayetiyle başvuran, akut apandisit şüphesiyle USG ve BT görüntülemesi yapılan ve bu nedenle opere edilen erişkin hastalara ait veriler retrospektif olarak tarandı. Hastaların demografik özellikleri, görüntüleme sonuçları ve ameliyat sonrası patoloji sonuçları kaydedildi.

Bulgular: Akut apandisit şüphesi olan 1030 vakadan 289'una (% 28) BT incelemesi yapıldığı tespit edildi. Hastaların ortanca yaşı 33'tü (IQR: 24-43) ve bunların% 54'ü erkekti. Akut apandisit tanısında patoloji raporları altın standart olarak kabul edildi. Elde edilen sonuçlara göre, BT görüntülemenin şüpheli vakalarda bile etkili olduğu saptandı (p <0.01). ROC analizinde AUC değeri 0.652 (% 95 CI: 0.546-0.727) idi. Ameliyat sonrası patoloji raporlarında akut apandisit tanısı doğrulanmayan 28 olguda (% 9), mezenterik lenfadenit (n: 16), malignite (n: 6), normal bulgular (n: 3), akut pelvik inflamatuar hastalık (n: 2) ve divertikülit (n: 1) tespit edildi. Bu hastaların 22'si (%78) kadındı.

Sonuç: Bilgisayarlı tomografi, acil servise karın ağrısı sebebiyle başvuran ve akut apandisit şüphesi olan hastaların ayırıcı tanısında etkili bir görüntüleme yöntemidir. Özellikle kadın hastalarda akut apandisit dışında ek ciddi tanılar da tespit edilebilmektedir.

Anahtar Kelimeler

Akut apandisit, bilgisayarlı tomografi, ayırıcı tanı

Computed Tomography In Differential Diagnosis Of Abdominal Pain Among Patients With Suspected Acute Appendicitis

Öz

Objectives: Acute appendicitis is mostly diagnosed in clinic evaluation and with ultrasonography (USG). Computed tomography (CT) is often preferred as an advanced imaging to clarify the causes of abdominal pain. In this study, the diagnostic effectiveness of CT in cases of suspected acute appendicitis was investigated.

Methods: The data from the adult patients who had applied to the emergency department with abdominal pain, undergone USG and CT imaging with suspected acute appendicitis and operated with that reason were scanned retrospectively. The demographic characteristics, imaging results and post-operative pathology results of the patients were recorded. 

Results: It was found that 289 (28%) of the 1030 cases having suspected acute appendicitis had undergone CT imaging. The median age of the patients was 33 years (IQR: 24-43) and 54% of those were male. The pathology reports were accepted to be golden standard for the diagnosis of acute appendicitis. According to the results obtained, CT imaging was found to be effective even in suspected cases (p<0.01). In the ROC analysis, the AUC value was 0.652 (95% CI: 0.546-0.727). In 28 cases (9%) for which the diagnosis of acute appendicitis was not verified in the post-operative pathology reports, lymphatic adenitis (n:16), malignity (n:6), normal findings (n:3), acute pelvic inflammatory disease (n:2) and diverticulitis (n:1) were detected. Of those patients, 22 (78%) were females.

Conclusion: Computed tomography is an effective method of imaging in differential diagnosis of patients who apply to the emergency department with abdominal pain and who have suspected acute appendicitis. Especially in female patients, additional serious diagnoses other than acute appendicitis can also be detected.

Anahtar Kelimeler

Acute appendicitis, computed tomography, differential diagnosis

Kaynakça

• 1. Liang MK, Andersson RE, Jaffe BM, Berger DH. The Appendix. In: Brunicardi FC, Andersen DK, Billiar TR, et al. editors. Schwartz’s Principles of Surgery. 10 ed. New York, McGraw-Hill Education; 2014. p.1241-62.
• 2. Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006;333(7567):530-4.
• 3. DeKoning EP. Acute appendicitis. In: Tintinalli JE, Stapczynski JS, Ma OJ, et al. editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8th ed. New York, NY:McGraw-Hill; 2016.p.532-36.
• 4. Wolfe JM, Henneman PL. Acute appendicitis. In: Marx JA, Hockberger RS and Walls RM editors. Rosen's Emergency Medicine: Concepts and Clinical Practice, 8 th edition, 2014.p.1225-35. 5. Raman SS, Lu DSK, Kadell BM, et al. Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: A 5-year review. Am J Roentgenol. 2002; 178:1319.
• 6. Atahan K, Ureyen O, Aslan E, et al. Preoperative Diagnostic Role of Hyperbilirubinaemia as a Marker of Appendix Perforation. J Int Med Res. 2011;39(2):609-18.
• 7. Koo HS, Kim HC, Yang DM, et al. Does computed tomography have any additional value after sonography in patients with suspected acut appendicitis. J Ultrasound Med. 2013 Aug;32(8):1397-1403.
• 8. Drake FT, Flum DR. Improvement in the diagnosis of appendicitis. Adv Surg. 2013;47:299-328.
• 9. Kontopodis N, Kouraki A, Panagiotakis G, et al. Efficacy of preoperative computed tomography imaging to reduce negative appendectomies in patients undergoing surgery for left lower quadrant abdominal pain. G Chir. 2014 Sep-Oct;35(9-10):223-8.
• 10. Van Randen A, Laméris W, van Es HW, et al. A comprasion of accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol. 2011 Jul;21(7):1535-45.
• 11. Johansson EP, Rydh A, Riklund KA. Ultrasound, computed tomography, and laboratory findings in the diagnosis of appendicitis. Acta Radiol. 2007;48:267–273.
• 12. Gamanagatti S, Vashisht S, Kapoor A, et al. Comparison of graded compression ultrasonography and unenhanced spiral computed tomography in the diagnosis of acute appendicitis. Singapore Med J. 2007;48:80–87.
• 13. Doria AS, Moineddin R, Kellenberger CJ, et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology. 2006;24:83–94.
• 14. Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg. 2007;245(6):886-92.