Year 2015 Vol. 23 No 2

GENERAL AND SPECIAL SURGERY

R.R. KASIMOV 1, A.S. MUKHIN, 2, D.A. ELFIMOV 1, A.M. SHELEH 1, A.I. MAKHNOVSKY 3

ULTRASOUND DIAGNOSTICS OF ACUTE APPENDICITIS

FSPE "422 Military Hospital" of the Ministry of Defense of Russia, N. Novgorod1,
SBEE HPE "Nizhny Novgorod State Medical Academy of the Ministry of Health" 2,
FSPE "422 Military Hospital" of the Ministry of Defense of Russia, St. Petersburg3
The Russian Federation

Objectives. To assess effectiveness of sonography in the diagnosis of acute appendicitis.
Methods. The analysis of ultrasound diagnostics effectiveness of acute appendicitis in the multidisciplinary in-patient general surgical military hospital has been performed. Sixty-five patients were enrolled in the analysis, sixty-four – younger men, one woman, thirty-four of them were operated on with a confirmed diagnosis of acute appendicitis. In one case, the histological examination verified catarrhal inflammation of the appendix (3%), the rest – a destructive acute appendicitis.
Results. The indices of informativeness of this method: sensitivity – 79%, specificity – 87%, overall accuracy – 68%, false negative response – 20%, false positive response – 13%, positive predicted value – 87%. Such characteristics of the appendix ultrasound as noninvasiveness, sufficient informativeness and the ability to perform research in dynamics, lack of radiation exposure to both a patient and staff provide undeniable advantages over the other methods of study. The application of the sonography of appendix in the clinical practice permitted to improve reliably the results of diagnosis and treatment of patients without any invasion as well as to reduce the incidence of “unreasonable” appendectomies.
Conclusion. Sonography of the appendix is an effective screening method for diagnosing acute appendicitis. High operator dependence can be considered as a disadvantage of this method. Currently, “unjustified” appendectomy is the most common diagnostic error, determining to a great extent the state and combatant value of patients operated on with acute appendicitis. A necessity to review some principles of specialists’ training for diversified general surgical hospitals has been appeared. It is expedient for surgeons to complete basic professional retraining with mastering of related specialties, particular ultrasound diagnostics and endoscopy.

Keywords: acute appendicitis, ultrasound diagnostics, endoscopy, unjustified appendectomy, destructive appendicitis, ultrasound examination of the appendix, diagnostic algorithm
p. 160-164 of the original issue
References
  1. Izrailov RE, Lemeshko ZA. Ul'trazvukovoe issledovanie v diagnostike i lechenii ostrogo appenditsita [Ultrasound examination in the diagnosis and treatment of acute appendicitis].Moscow, RF: GEOTAR–Media, 2009. 72 p.
  2. Piskunov VN, Zavadovskaia VD, Zav'ialova NG. Ul'trazvukovaia diagnostika ostrogo appenditsita [Ultrasound diagnosis of acute appendicitis]. Biull Sib Meditsiny. 2009;(4):140-49.
  3. Magomedova SM, Abduldzhalilov MK. Ekhosonografiia v diagnostike ostrogo appenditsita pri atipichnom raspolozhenii cherveobraznogo otrostka [Echosonography in the diagnosis of acute appendicitis at atypical location of the appendix]. Sovr Naukoemkie Tekhnologii. 2010;(2):99-100.
  4. Bakker OJ, Go PM, Puylaert JB, Kazemier G, Heij HA. Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is recommended. [Article in Dutch] Werkgroep richtlijn Diagnostiek en behandeling van acute appendicitis. Ned Tijdschr Geneeskd. 2010;154:A303.
  5. Gökçe AH, Aren A, Gökçe FS, Dursun N, Barut AY. Reliability of ultrasonography for diagnosing acute appendicitis. [Article in Turkish] Ulus Travma Acil Cerrahi Derg. 2011 Jan;17(1):19-22.
  6. Toorenvliet BR, Wiersma F, Bakker RF, Merkus JW, Breslau PJ, Hamming JF.Routine ultrasound and limited computed tomography for the diagnosis of acute appendicitis. World J Surg. 2010 Oct;34(10):2278-85. doi: 10.1007/s00268-010-0694-y.
  7. Kukosh MV, Gomozov GI. Puti snizheniia letal'nosti pri ostrom appenditsite [The methods to reduce mortality in acute appendicitis]. Nizhegorod Med Zhurn. 2006;(6):71-76.
  8. Borisov AE, Levin LA, Peshekhonov SI, Chistiakov DB, Shikhllagolledov ShA, Kim AE, Khlopov VB, Kornienko BL, Pikin IV. Laparoskopicheskaia appendektomiia [Laparoscopic appendectomy]. Oshibki i oslozhneniia. SPb MDPO, Saint-Petersburg, RF. Endoskop Khirurgiia. 2009;(1):91-92.
  9. Ukhanov AP, Kovalev SV, Iashina AS, Ignat'ev AI. Vozmozhnosti ul'trazvukovoi diagnostiki ostrogo appenditsita [Possibilities of ultrasound diagnosis of acute appendicitis]. Endoskop Khirurgiia. 2009;(1):84-85.
  10. Kasimov RR, Mukhin AS, Elfimov DA, Sokolov LV. Lechebno-diagnosticheskii algoritm pri ostrom appenditsite u voennosluzhashchikh [Diagnostic and treatment algorithm for acute appendicitis in military personnel]. Novosti Khirurgii. 2014;1(22):89-95.
Address for correspondence:
603105, Rossiyskaya Federatsiya,
g. N. Novgorod, ul. Izhorskaya, d. 25, k. 3,
Nizhegorodskiy voennyiy gospital,
khirurgicheskoe otdelenie,
tel. mob.: 7 (920) 035-06-19,
e-mail: rusdoc77@mail.ru,
Kasimov Rustam Rifkatovich
Information about the authors:
Kasimov R.R. PhD, a surgeon of FSPE "422 military hospital" of the Ministry of Defense of Russia.
Mukhin A.S. MD, professor, a head of the surgery chair of the faculty of advanced training of SBEE HPE "Nizhny Novgorod State Medical Academy of the Ministry of Health".
Elfimov D.A. A surgeon of FSPE "422 military hospital" of the Ministry of Defense of Russia.
Sheleh A.M. A head of the ultrasound diagnostic unit of FSPE "422 military hospital" of the Ministry of Defense of Russia.
Makhnovsky A.I. A chief surgeon of Western Military District of FSPE "422 military hospital" of the Ministry of Defense of Russia (St. Petersburg).
Contacts | ©Vitebsk State Medical University, 2007-2023