According to a study by Xu et al published in the Journalof Ultrasound in Medicine ultrasound can provide information regarding the
preferred treatment i.e. proceed with
appendectomy or try antibiotics first in patients with appendicitis.
The authors reviewed
retrospectively sonographic studies of 119 patients with histopathologically
proven appendicitis. The diagnostic
criteria and the preferred treatment in patients with suspected appendicitis was
the presence or absence of the normally echogenic submucosal layer, the
presence of mural hyperemia, periappendiceal fluid, appendicoliths, and
hyperechoic periappendiceal fat and the maximum outside diameter.
Thirty-two (27%) of the 119
patients had complicated appendicitis, including 11 with gangrenous
appendicitis without perforation and 21 with gangrenous appendicitis and
perforation. Loss of the submucosal layer was the only independent significant
indicator of complicated appendicitis (P < .001) and provided sensitivity and specificity values of
100.0% and 92.0% respectively.
The researchers concluded if loss
of echogenic submucosal layer was detected at sonograpy the diagnosis of complicated appendicitis was likely and, therefore, surgery was
necessary. On the other hand, when ultrasound did not show loss of the
submucosal layer, antibiotic therapy should be tried, as the likely diagnosis
is uncomplicated appendicitis.
