針原 康¹, 田中 信孝¹, 浅田 学², 関根 智紀³

Yasushi HARIHARA¹, Nobutaka TANAKA¹, Manabu ASADA², Tomoki SEKINE³

¹旭中央病院外科, ²旭中央病院内科, ³旭中央病院超音波検査室

¹Department of Surgery, Asahi General Hospital, ²Deparment of Internal Medicine, Asahi General Hospital, ³Division of Ultrasonography, Asahi General Hospital

キーワード : Acute appendicitis, Ultrasonographical criteria for the operative decision, Inflammatory grade of appendicitis, Paralytic intestine, Outer diameter of appendix

This report summarizes our first experience using our ultrasonographical criteria for deciding whether to operate on acute appendicitis. Our criteria is based on the concept that appendectomies should be performed only if inflammatory grade of appendicitis has reached a certain level. Our criteria consists of direct visualization of inflamed enlarged appendix (an outer diameter over 8 mm) and ancillary findings such as abscess formation, intra-abdominal fluid collection and paralytic intestines. These ancillary findings are very important because they represent the spread of inflammatory change beyond the appendix. An operation should be considered if these ancillary findings are apparent, even if the appendix cannot be visualized. This criteria was used for 179 patients with suspected appendicitis, and was proved to have a sensitivity of 90.5%, a specificity of 94.8% and an overall accuracy of 93.3%. The negative appendectomy rate decreased from 31.3% to 9.5% using ultrasonographical evaluation. Our results suggest that this ultrasonographical criteria for laparotomy is of particular value for patients with suspected appendicitis.