Sonographic criteria in the diagnosis and treatment of appendicitis.

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.