distinguishing perforated from non-perforated appendicitis is of high importance, as treatment and management dramatically differs. This study aimed at investigating the relationship between ultrasound features of appendix and risk of subsequent perforated appendicitis in patients with acute appendicitis.
This descriptive-analytical study was conducted on 43 patients with final surgical diagnosis of acute appendicitis. All patients underwent ultrasound exam on admission, utilizing both linear (7-8 MHz) and curved (4-5 MHz) transducers. Two radiologists blinded to patients historical and clinical data, performed ultrasound exam on all participants following a systematic approach. Cases of mismatch were resolved in consensus. Tissue harmonic imaging function was turned on for all cases.
According to our results, submoucosal layer visibility in case with final surgical diagnosis of perforated appendicitis was significantly lower than that of patients with non-perforated appendicitis (P <0.001). Prevalence of appendicolith, and peri-appendiceal fluid collection was not significantly different between the two subgroups (P< 0.05). Incidence of peri-appendiceal abscess was far more common in case of perforated appendicitis, comparing to the other subgroup (p> 0.05)
Lack of visibility of appendiceal submucosal layer and visualizing peri-appendiceal abscess in ultrasound are highly associated with subsequent appendicitis perforation.