AKUT APANDİSİT TANISINDA BİLGİSAYARLI TOMOGRAFİNİN YERİ

Yıl 2014, Cilt: 4 Sayı: 3, 29 - 33, 03.12.2014

Bahadır Celep , Ahmet Bal Mustafa Özsoy Ziya Özkeçeci Kamil Tunay Ogün Erşen Yüksel Arıkan

Öz

ÖZET
Amaç: Akut apandisit (AA) günümüzde en sık gerçekleştirilen acil abdominal cerrahi işlemdir. Tedavisinde gecikme yüksek mortalite ve morbidite ile seyretmekte olup erken tanı ve tedavi hayat kurtarıcıdır. Bu çalışmada bilgisayarlı tomografinin (BT) AA tanısındaki yerinin ortaya konması amaçlandı.
Gereç ve Yöntemler: 2009-2013 yılları arasında AA ön tanısıyla ameliyat edilen 338 hastanın hastane ka- yıtları retrospektif olarak tarandı. Hastaların ameliyat öncesi yapılan BT ve abdominal ultrasonografi (USG) sonuçları ile postoperatif patoloji sonuçları korele edilerek radyolojik tetkiklerin tanıdaki etkinlikleri de- ğerlendirildi.
Bulgular: 338 hastanın 286’sında (%84,62) postoperatif patoloji sonucu apandisit olarak rapor edildi. 267 hastaya apandisit tanısı yalnızca USG kullanılarak konuldu, sadece BT ile tanı konan hasta sayısı 11, hasta- ların 60’ına her iki tetkik beraber yapıldı. BT çekilme endikasyonlarına bakıldığında en sık (60 hastada % 84,51) USG ile AA tanısının dışlanamaması veya suboptimal inceleme sebebiyle, 11 hastada ise jeneralize akut batın tablosu olması üzerine USG olmadan BT çekilmiştir. BT çekilen 71 hastadan 54’ünde postoperatif patoloji tanısı apandisit olarak raporlandı.
Radyolojik tetkikler ile postoperatif patoloji sonuçları karşılaştırıldığında USG ve BT için pozitif tanı de- ğerleri sırasıyla % 85,02 ve % 88,89’du. Doğruluk değerleri ise USG ve BT için sırasıyla % 72,78 ve % 87,32 olarak saptandı.
Sonuç: AA tanısında hastanın hikayesi ve fizik muayenesi önemlidir. Ancak şüpheli ve ayırıcı tanı gerektiren olgularda görüntüleme yöntemleri kullanılmalıdır. İlk tercih genellikle USG olmakla birlikte AA tanısında BT yüksek doğruluk ve duyarlılık oranlarına sahiptir. Özellikle USG’nin yetersiz kaldığı durumlarda BT tercih edilmelidir.
Anahtar kelimeler: Akut apandisit; Ultrasonografi; Bilgisayarlı tomografi
ABSTRACT
Objective: Acute appendicitis (AA) is the most commonly performed emergency abdominal surgery. Delay in treatment is associated with high mortality and morbidity rates and early diagnosis and treatment is lifesaving. In this study, we aimed to investigate the diagnostic value of computed tomography (CT) in the diagnosis of AA.
Materials and Methods: The hospital records of 338 patients with a preliminary diagnosis of AA who underwent surgery between 2009-2013 were reviewed retrospectively. Patients’ preoperative CT and abdominal ultrasonography (USG) reports were correlated with the results of postoperative pathologic results. We evaluated the efficacy of radiological examinations in the diagnosis.
Results: In the 286 of 338 patients (84.62%) postoperative pathologic results were reported as appen- dicitis. The diagnosis of appendicitis was made using only USG in 267 patients, the number of patients diagnosed with only CT was 11, and 60 of the patients had the diagnosis with both tests.
Considering the most common indications for CT (60 patients, 84.51%) were insufficiency of USG in the exclusion of AA or suboptimal study, and in 11 patients due to generalized acute abdomen. 54 of the 71 patients who had CT prior to surgery, postoperative pathologic diagnosis were reported as appendicitis. When the radiological tests were compared with the postoperative pathologic results; the positive predic- tive value of ultrasound and CT were 85.02% and 88.89%, respectively. The accuracy of USG and CT were 72.78% and 87.32%, respectively.
Conclusion: Patient’s history and physical examination have undeniable importance in the diagnosis of AA. However, imaging methods should be used for diagnosis of the vague cases. CT was founded to be superior to USG in the diagnosis of AA.
Key words: Acute appendicitis; Ultrasonography; Computed Tomography

Anahtar Kelimeler

Akut apandisit; Ultrasonografi; Bilgisayarlı tomografi

Kaynakça

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