Diagnostik bei Verdacht auf Appendicitis – Lässt sich eine akute Appendicitis sonographisch ausschließen?

摘要

Introduction: Acute appendicitis is often difficult to confirm and even harder to rule out by physical examination. In order to assess the diagnostic reliability of sonography we compared the results of physical (p) and sonographic (s) examination. Method: One hundred and fifty consecutive patients presenting with right lower quadrant abdominal pain were evaluated in a prospective study. Based on the respective findings patients were classified into three groups: I: appendicitis confirmed; II: appendicitis ruled out; III: equivocal findings. The results were compared with the discharge diagnoses established by histologic examination or clinical observation. Results: Ultrasonography showed significantly higher sensitivity (group I s vs group I p: 95 % vs 45 %) and specificity (group I s vs group I p: 100 % vs 75 %) in confirming as well as in ruling out acute appendicitis (group II s vs group II p: sensitivity 73 % vs 53 %; specificity 100 % vs 81 %) than physical examination alone. Owing to additional sonographic findings the group with indeterminate abdominal pain was much smaller after ultrasound examination (group III s vs group III p: 35 vs 69 patients). Conclusions: After discussing the literature and sonomorphologic criteria that distinguish an inflamed from a normal appendix, we conclude that ultrasonography is a valuable tool in confirming as well as in ruling out acute appendicitis.