A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

To establish the value of breathhold magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis. Over a 14-month period, 138 patients clinically suspected of having appendicitis were evaluated prospectively with MRI and comprised the study group. Fast turbo spin-echo breathhold T1, T2 and T2 fat suppression sequences were used in coronal and axial planes. The imaging results were recorded separately and subsequently correlated with clinical, radiological and histopathological follow-up. The effect of imaging strategies in patients suspected of appendicitis on hospital resources was calculated. Sixty-two of the 138 patients had a histopathologically proven appendicitis. MRI determined appendicitis in 63 patients, with one examination being false positive. The resulting sensitivity and specificity were 100% and 99%, respectively. MRI showed an alternative diagnosis in 41 of the 75 remaining patients. In 22 of the remaining 34 patients, a normal appendix was depicted with MRI. In two patients, where MRI showed no appendicitis, an alternative diagnosis or normal appendix, an unnecessary appendectomy was performed. The overall effect of using MRI in patients suspected of appendicitis on the use of hospital resources could have been a net saving between € 55,746 and € 72,534. MRI has a high accuracy in detecting and excluding appendicitis, an alternative diagnosis or showing the normal appendix, and can be a valuable and cost-effective tool in the workup of patients clinically suspected of having appendicitis.     

Appendicolithiasis versus urolithiasis

An unusual clinical presentation of appendicitis with violent colicky pain as seen classically in urolithiasis is here presented. The pathophysiology of colic and the differential diagnosis of appendicolithiasis is briefly discussed. Received: 6 April 1999 / Accepted in revised form: 3 June 1999     

阑尾炎的超声诊断技巧与图像分析

目的：合理利用超声检查手法提高识别阑尾炎的不同表现。方法：回顾分析经常规二维超声检查并经手术证实的178例阑尾炎的超声探查手法技巧和图像表现并进行总结。结果：在178例中超声检查与临床手术符合率为87%，除了要有必要的经验和认识外，超声的检查手法是关键。结论：以压痛点为轴加压、以纵切方向探查为主、小角度小范围垂直探查，有利于非典型阑尾炎病灶的发现；而且超声诊断定位性好，有利于临床选择手术切口。     

CT evaluation of appendicitis and diverticulitis. Part I: Appendicitis

CT has become the primary imaging modality for evaluation of possible appendicitis. About 20 % of patients taken to surgery for appendicitis without CT have had a normal appendix removed. CT has demonstrated overall accuracy of between 93 % and 98 %. Alternative diagnoses are seen in 34–80 % of patients without appendicitis but who were suspected of having appendicitis. For evaluation of appendicitis different techniques have been successful, including the use of no contrast, use of oral and intravenous contrast, and use of rectally administered contrast. Scanning of the entire abdomen and pelvis and scanning of an area limited to the right lower quadrant are also options. Ultrasonography has been shown to have a role in pediatric patients. If ultrasonography is positive, CT is not necessary. If ultrasonography is negative, CT should follow.     

急性坏疽性阑尾炎治疗探讨

30例急性坏疽性阑尾炎，对阑尾根部坏死、组织水肿、脆弱者，采取间断缝合阑尾残端及大网膜覆盖，保持引流通畅，合理的应用抗生素治疗，未发生1例肠瘘，达到满意效果。     

Eosinophils,mast cells,nerves and ganglion cells in appendicitis

Introduction  

Twenty to thirty percent appendices removed from patients with suspected appendicitis appear normal on histology. The cause of pain in these patients is unknown. The presence of eosinophils and mast cells should be looked at skeptically which may explain the cause of pain. The aim was to study the eosinophils, mast cells, nerves and ganglions in normal and inflamed appendices.     

一起阑尾炎暴发的流行病学调查

采用病例对照设计比较患者和对照的既往病史和暴露史，以探讨一起阑尾炎暴发的原因。１９９７ 年４ 月１１ 日至１０月１ 日，武汉市某中学出现１３ 例阑尾炎患者，９ 例发生于５ 月１２ 日至６ 月１３ 日之间。学生罹患率为４１ ％ （１２／２９０） ，９ 个班中５ 个班有学生发病，分别为１ 、２ 、２ 、３ 、４ 例，呈聚集趋势。患者中学习紧张和吃冷饮 的比例多于对照，病检显示病毒性阑尾炎特征。综上，本次暴发似由传染因子所致，学习紧张和吃冷饮似为辅助因素。     

"阑尾压痛带征"的临床研究

目的用弹簧称标示重量作“阑尾压痛带征”研究。方法用此“压痛器”对腹部作定位定量施压，每距1cm左右作压痛测试压痛点，将各点连成一线提示阑尾的位置，称为“阑尾压痛带征”。共进行150例临床前瞻性研究。结果150例均能引出“阑尾压痛带征”，其中手术结果与压痛带征全部符合者136例（90．7％），基本符合者9例（6．0％），不符合者5例（3．3％）。经压痛带征检查145例，行阑尾切除手术时间平均43min33S，未进行阑尾压痛带检查的100例，行阑尾切除手术时间平均77min6So结论压痛带征是存在的，其可提高对阑尾炎的确诊率，缩短阑尾切除手术时间，减少手术创伤，便于寻找阑尾，减少对腹腔脏器的扰乱，节省住院费用，减少不必要的昂贵检查。     

Sonography of ruptured appendicitis

Three girls and 4 boys with the final diagnosis of ruptured appendicitis underwent 19 sonographic studies, 5 before any therapy was instituted and 14 follow-up studies. Four abscesses identified before treatment and 2 seen postoperatively were ovoid, irregularly marginated, and contained lowamplitude echoes. Gastrointestinal ileus with gas- and fluid-filled loops of bowel made the studies technically difficult. Follow-up studies also showed fluid collections distant from the original abscesses. The complete resolution of the abscess was followed sonographically in 1 patient treated with antibiotics. Ultrasound can be useful in confirming or suggesting the diagnosis of ruptured appendicitis in the child with abdominal pain, but careful attention to detail is necessary in these technically difficult studies.     

Outcome of initially nonoperative treatment for acute simple appendicitis in children

Purpose

To compare the outcome of initially nonoperative treatment with immediate appendectomy for simple appendicitis in children.