Prashanth Venkateswaran1, Vinjamuri Anuradha2, Puneet Shirbur3
BACKGROUND
Acute appendicitis is one of the commonest causes of pain abdomen. Appendicitis
has a good prognosis but a delay in diagnosis may result in risk of perforation,
peritonitis, abscess formation, sepsis, and even death.
METHODS
A retrospective study was conducted from December 2019 to April 2020 in MVJ
Medical College and the pre-operative ultrasonographic images of all the patients
who underwent surgery for suspected acute appendicitis were reviewed. A total
of 50 such cases were found and included in the study. The direct signs were
enlarged appendix, hyperaemia of wall of appendix, non-compressibility and
appendicolith. The indirect signs were increased echogenicity and thickening of
mesenteric fat in right iliac fossa (RIF), increased vascularity in RIF, thickening of
caecal wall, RIF probe tenderness, free fluid in the RIF and mesenteric
lymphadenopathy.
RESULTS
32 (64 %) were in the adult age group and 18 (36 %) patients were in the
paediatric age group (below 18 years); the mean age was 38 years. 68 % (34) of
the study population were males and 32 % (16) were females. At least one direct
sign was present in 86 % of the cases, 2 and 3 direct signs were seen in 80 %
and 56 % of the cases respectively. At least 1 indirect sign was noted in 97 % of
the cases, 2 and 3 indirect signs were seen in 90 % and 70 % of the cases
respectively. 2 cases had no indirect signs and all indirect signs were present in
none of the cases studied. In the absence of direct signs, RIF probe tenderness
(98 %) and increased echogenicity & thickness of mesenteric fat in RIF (86 %)
were the most noted indirect signs in acute appendicitis.
CONCLUSIONS
There was a high incidence of indirect ultrasonography (USG) signs, of which the
sign with maximum incidence was probe tenderness in 98 % of the cases, and
increased mesenteric fat echogenicity in the RIF in 86 %. Among direct signs of
acute appendicitis enlarged appendix (95 %) had the highest incidence followed
by non-compressibility of appendix (90 %).
