Akut appendisitin ÇKBT tanısında appendiks bükülme açısı ek bir tanısal bulgu olabilir mi?

Yıl 2020, Cilt: 4 Sayı: 1, 76 - 81, 02.03.2020

Nurcan Ertan Tuba Akdağ , İrmak Durur Subaşı İsmail Oskay Kaya , Baki Hekimoglu

https://doi.org/10.30565/medalanya.622116

Cited By: 1

Öz

Amaç: Bilgisayarlı tomografi (BT), akut apandisit tanısında sık kullanılan bir görüntüleme yöntemidir. Akut apandisiti saptamak için BT'de en sık kullanılan ölçüm; apendiks en geniş dış çapının transvers düzlemde ölçümüdür. Birçok çalışma apendiks duvar kalınlığı, apendiks duvar kontrastlanması, peri-apendiküler serbest sıvısı, peri-apendiküler enflamasyon, peri-apendiküler lenf nodu, apendikolit ve çekum duvar kalınlaşması gibi akut apandisitin diğer BT bulgularını bildirilmiştir. Biz çalışmamızda akut apandisit tanısında apendiks bükülme açısının (ABA) tanıya ek ve yeni bir bulgu olarak katkısını araştırdık.
Yöntemler: Bu retrospektif çalışma enstitüden etik kurul onayı alındıktan sonra yapıldı. Çalışma grubuna ardışık tarihlerde apendektomi yapılan 52 hasta alındı. Akut batın dışı nedenlerle abdominal BT çekilen hastalardan da kontrol grubu oluşturuldu.
Bulgular: Akut apandisit grubunun yaş ortalaması 41.9 ± 16.0 idi. Erkek hastalar çoğunluktaydı (n = 32, %61.5). Akut apandisit grubunda peri-apendiküler inflamasyon %65.4, peri-apendiküler lenf nodu %73.1 ve apendikolit %9.6 oranlarında pozitif bulundu. Ortalama ABA, çalışma grubunda 103.0 ± 15.9 derece, kontrol grubunda ise 118.8 ± 23.8 derece idi (p <0.001). ABA'nın duyarlılığı % 76.9 olarak hesaplandı ve özgüllüğü ROC eğrisi ile hesaplanan en iyi kesme noktası olan 113.15 derecede % 58.3 idi. 142.3 derecenin üzerinde akut apandisit saptanmadı.
Sonuç: ABA’nın azalmış olması akut apendisit tanısında ek bir bulgu olarak kullanılabilir. 

Anahtar Kelimeler

Akut apandisit, Bükülme açısı, çok kesitli bilgisayarlı tomografi

Can appendix bending angle be an additional finding to detect acute appendicitis on MDCT?

Öz

Aim: Computed tomography (CT) is frequently used as an imaging modality in the evaluation of acute appendicitis. The most frequently used measurement to detect acute appendicitis is maximal outer diameter of appendix on CT and several studies have reported other CT findings of acute appendicitis, such as thickness of the appendiceal wall, appendiceal wall enhancement, peri-appendiceal free fluid, peri-appendiceal inflammation, peri-appendiceal lymph node, appendicolith and cecal wall thickening. We investigated the value of the appendix bending angle (ABA) as an additional and novel finding in the diagnosis of acute appendicitis. 

Methods: This retrospective study was conducted after the local ethics committee’s approval. 52 consecutive patients who underwent appendectomies were assigned to the study group. The patients, who underwent abdominopelvic CT for any other reason than acute abdomen, were included as control group. 

Results: The mean age of the appendicitis group was 41.9±16.0; male predominance was present (n=32, 61.5%). Peri-appendiceal inflammation was seen in 65.4%, peri-appendiceal lymph node was seen in 73.1% and appendicolith was present in 9.6% of the appendicitis group. The mean ABA was 103.0±15.9 degree in study group and 118.8±23,8 degree in control group respectively (p<0.001). The sensitivity of ABA was calculated as 76.9% and the specificity was 58.3% at 113.15 degree which is the best cut-off point calculated by ROC curve. There was no appendicitis over 142.3 degrees. 

Conclusion: ABA can be used as an additional finding which is decreased in acute appendicitis.

Anahtar Kelimeler

Acut appendcitis, Bending angle, Multidedactor computed tomography

Kaynakça

• 1. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-925 DOI: 10.1093/oxfordjournals.aje.a115734 2. Allievi N, Harbi A, Ceresoli M, Montori G, Poiasina E, Coccolini F, Pisano M, Ansaloni L. Acute Appendicitis: Still a Surgical Disease? Results from a Propensity Score-Based Outcome Analysis of Conservative Versus Surgical Management from a Prospective Database. World J Surg. 2017;41(11):2697-705. DOI:10.1007/s00268-017-4094-4
• 3. Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, Nyhsen C, Owens CM. How to diagnose acute appendicitis: ultrasound first. Insights Imaging. 2016;7(2):255-63. DOI:10.1007/s13244-016-0469-6
• 4. McDonald GP, Pendarvis DP, Wilmoth R, Daley BJ. Influence of preoperative computed tomography on patients undergoing appendectomy. Am Surg. 2001;67(11):1017-21 PMID: 11730216
• 5. Raman SS, Osuagwu FC, Kadell B, Cryer H, Sayre J, Lu DS. Effect of CT on false positive diagnosis of appendicitis and perforation. N Engl J Med. 2008;358(9):972-73. DOI:10.1056/NEJMc0707000
• 6. Kabir SA, Kabir SI, Sun R, Jafferbhoy S, Karim A. How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence. Int J Surg. 2017;40:155-62. DOİ:10.1016/j.ijsu.2017.03.013
• 7. Tamburrini S, Brunetti A, Brown M, Sirlin CB, Casola G. CT appearance of the normal appendix in adults. Eur Radiol. 2005;15(10):2096-103. DOI:10.1007/s00330-005-2784-z
• 8. Jan YT, Yang FS, Huang JK. Visualization rate and pattern of normal appendix on multidetector computed tomography by using multiplanar reformation display. J Comput Assist Tomogr. 2005;29(4):446-51 DOI: 10.1097/01.rct.0000164668.03767.53
• 9. Kim HC, Yang DM, Jin W. Identification of the normal appendix in healthy adults by 64-slice MDCT: the value of adding coronal reformation images. Br J Radiol. 2008;81(971):859-64. DOI:10.1259/bjr/19297777
• 10. Celep B, Bal A, Özsoy M, Özkeçeci Z, Tunay K, Erşen O, Arıkan Y. Akut apandisit tanısında bilgisayarlı tomografinin yeri. Bozok Tıp Dergisi. 2014;4(3):33-29
• 11. Simonovsky. Sonographic detection of normal and abnormal appendix. Clin Radiol. 1999;54 (8):533-39 DOI: 10.1016/s0009-9260(99)90851-6
• 12. Ives EP, Sung S, McCue P, Durrani H, Halpern EJ. Independent predictors of acute appendicitis on CT with pathologic correlation. Acad Radiol. 2008;15(8):996-1003. DOI:10.1016/j.acra.2008.02.009
• 13. Lee SY, Coughlin B, Wolfe JM, Polino J, Blank FS, Smithline HA. Prospective comparison of helical CT of the abdomen and pelvis without and with oral contrast in assessing acute abdominal pain in adult Emergency Department patients. Emerg Radiol. 2006;12(4):150-57. DOI:10.1007/s10140-006-0474-z
• 14. Mun S, Ernst RD, Chen K, Oto A, Shah S, Mileski WJ. Rapid CT diagnosis of acute appendicitis with IV contrast material. Emerg Radiol. 2006;12(3):99-102. DOI:10.1007/s10140-005-0456-6
• 15. Bursali A, Arac M, Oner AY, Celik H, Eksioglu S, Gumus T. Evaluation of the normal appendix at low-dose non-enhanced spiral CT. Diagn Interv Radiol. 2005;11(1):45-50. PMID: 15795844
• 16. Rettenbacher T, Hollerweger A, Macheiner P, Rettenbacher L, Tomaselli F, Schneider B, Gritzmann N. Outer diameter of the vermiform appendix as a sign of acute appendicitis: evaluation at US. Radiology. 2001;218(3):757-62. DOI:10.1148/radiology.218.3.r01fe20757
• 17. Vignault F, Filiatrault D, Brandt ML, Garel L, Grignon A, Ouimet A. Acute appendicitis in children: evaluation with US. Radiology. 1990;176(2):501-04. DOI:10.1148/radiology.176.2.2195594
• 18. Sivit CJ. Diagnosis of acute appendicitis in children: spectrum of sonographic findings. AJR Am J Roentgenol. 1993;161(1):147-52. DOI:10.2214/ajr.161.1.8517294
• 19. Quillin SP, Siegel MJ. Appendicitis: efficacy of color Doppler sonography. Radiology. 1994;191(2):557-60. DOI:10.1148/radiology.191.2.8153340
• 20. Rao PM, Rhea JT, Novelline RA. Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. J Comput Assist Tomogr. 1997;21(5):686-92 DOI: 10.1097/00004728-199709000-00002
• 21. Shindoh J, Niwa H, Kawai K, Ohata K, Ishihara Y, Takabayashi N, Kobayashi R, Hiramatsu T. Predictive factors for negative outcomes in initial non-operative management of suspected appendicitis. J Gastrointest Surg. 2010;14(2):309-14. DOI:10.1007/s11605-009-1094-1
• 22. Ishiyama M, Yanase F, Taketa T, Makidono A, Suzuki K, Omata F, Saida Y. Significance of size and location of appendicoliths as exacerbating factor of acute appendicitis. Emerg Radiol. 2013;20(2):125-30. DOI:10.1007/s10140-012-1093-5
• 23. Gunes Tatar I, Yilmaz KB, Sahin A, Aydin H, Akinci M, Hekimoglu B. Evaluation of Clinical Alvarado Scoring System and CT Criteria in the Diagnosis of Acute Appendicitis. Radiol Res Pract. 2016;2016:9739385. DOI: 10.1155/2016/9739385
• 24. Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C. CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol 185. 2005;(2):406-17. DOI:10.2214/ajr.185.2.01850406