Ultrasonography for acute appendicitis – the way it looks today

Abstract

Despite sophisticated physical examination and laboratory support, diagnosis of acute appendicitis remained challenging in clinical practice with a negative appendectomy rate of 15 – 30 %. As a remarkable clue and as early as 1986, ultrasonography (US) has been proven a reliable diagnostic method that is also explicitly helpful in difficult cases with atypical presentation and enables to rule out many differential diagnoses.

Recent publications emphasized the role of multidetector computed tomography (CT) resulting in a significant reduction of false negative findings at operation. Extensive as well as uncritical application of this method even in children inevitably causes substantial radiation exposure, a sequel to either pure ignorance or unqualified/inadequate performance of US in this particular situation, which in turn can be considered sequel to either egocentric or economic preponderance.

Recent data shed new light on the role of US (and CT) in acute appendicitis. Therefore, 1 generation after US with graded compression was etched in stone as the method of choice for diagnosing acute appendicitis (Puylaert), a visual arousal fostering its role and performance in clinical medicine appears justified.

Zusammenfassung

Die Diagnostik der akuten Appendizitis ist durchaus anspruchsvoll und auch bei sorgfältiger Anamnese und klinischer Untersuchung mit 15 – 30 % unnötigen Appendektomien verbunden. Die Sonografie ist bei akuter Appendizitis eine seit 1986 validierte und etablierte Untersuchung und auch in schwierigen oder unklaren Situationen wegweisend für die Diagnosefindung und Differenzialdiagnostik.

Eine Reihe Publikationen attestieren der Multidetektor-Computertomografie (CT) eine wesentliche Rolle zur Reduktion falsch negativer Befunde bei der Appendektomie und haben dadurch zu einer erheblichen Zunahme von CTs bei Verdacht auf Appendizitis geführt. Dieser extensive CT-Einsatz mit zwangsläufig erheblicher Strahlenbelastung bei den zumeist (sehr) jungen Patient(inn)en impliziert entweder pure Ignoranz gegenüber der Ultraschalldiagnostik oder ihre unzureichend qualifizierte/inadäquate Durchführung im Spannungsfeld egozentrischer bzw. ökonomischer Anreize.

Kürzlich publizierte Daten präzisieren, spezifizieren und untermauern die Bedeutung der Sonografie als Primärdiagnostik bei der akuten Appendizitis; sie sind Veranlassung, 30 Jahre, nachdem Puylaert die Ultraschalluntersuchung mit dosierter Kompression als Methode der Wahl in Stein meißelte, die Rolle der Sonografie in Relation zur CT durch einen „optischen Weckruf“ zu betonen.

Schlüsselwörter

akute Appendizitis - Appendix - intestinaler Ultraschall - Computertomografie - Strahlenschutz

Key words

acute appendicitis - appendicitis - intestinal ultrasonography - computed tomography - radiation protection

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