VALUE OF ULTRASOUND IN DIAGNOSIS OF DISEASES IN ILEOCECAL REGION
Keywords:
transabdominal ultrasonography, gastrointestinal tract, appendicitis, inflammatory bowel diseases, gastrointestinal tumoursAbstract
Background. Frequent clinical diagnosis of diseases in ileocecal region is inconclusive and increases with age. Graded compression ultrasonography (US) improves diagnostic accuracy of acute appendicitis but it may be more difficult to carry out in adult patients and other diseases are more frequently in them. The author’s own experience in sonography of the ileocecal region is presented in this study.
Methods. 44 patients (15 m., 29 f., 11–76 y., mean 34.4 y.) with acute right lower abdominal pain (37) or with persistent pain after abdominal surgery (7) in the period from January 2000 to November 2002 were included in this study. Graded compression with convex 3.5 MHz and with linear 7.5 MHz probe on grayscale and Color Doppler sonography was performed. The results of US were correlated with operative findings (all appendicitisses, abscesses, mesenterial pseudocyst and malignancies) or with follow up (other).
Results. In 11/12 (91.7%) of patients with later surgically proved appendicitis, US diagnosed it (6 without / 5 with signs of perforation and abscess). In two patients it was false positive, but in one of them operation was justified because of other pathology. In 14/37 (37.8%) of patients with indeterminate right lower abdominal pain, US diagnosed it (10) or proved (4) some other diseases such as Crohn’s disease (3), mesenteric lymphadenitis (2), infectious ileocecitis (3), ovarian tumour (1), adnexitis (1), myoma in the right part of the uterus (1) and cecal cancer (3). In 10/37 (27%) of patients a disease in ileocecal region was excluded. US falsely diagnosed appendicitis in one of these patients. In 4/7 of operated patients abscesses were found while in others abdominal wall seroma (1), Crohn’s disease (1) and adnexitis (1). Diagnostic value of US in ileocecal region: sensitivity – 0.97, specificity – 0.90.
Conclusions. US is an accurate method in diagnosis of diseases in ileocecal region if graded compression with convex and high frequency linear probe on gray scale and color Doppler is performed. Because the preparation of patient is not necessary, it is regarded as appropriate method in diagnosis of acute ileocecal pathology.
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References
Puylaert JBCM. Acute appendicitis: US evaluation using graded compression. Radiology 1986; 158: 355–60.
Rainer S. US imaging in inflammatory and infectious diseases of the intestine. In: SONONET 98 – International Seminar in Diagnostic and Interventional Ultrasonography. Pula, Hrvaška, junij 1998.
Puylaert JB. Ultrasound of acute GI tract conditions. Eur Radiol 2001; 11: 1867–77.
Gritzmann N, Hollerweger A, Macheiner P, Rettenbacher T. Transabdominal sonography of the gastrointestinal tract. Eur Radiol 2002; 12: 1748–61.
Quillin SP, Siegel MJ. Color Doppler US of children with acute lower abdominal pain. Radiographics 1993; 13: 1281–93.
Rioux M, Gagnon J. Imaging modalities in the puzzling world of inflammatory bowel disease. Abd Imaging 1997; 22: 173–4.
Lehmann D, Uebel P, Weiss H et al. Sonographic representation of the normal and acute inflamed appendix – in patients with right-sided abdominal pain. Ultraschall Med 2000; 21: 101–6.
Esteban JM, Maldonado L, Sanchiz V et al. Activity of Crohn’s disease assessed by colour Doppler ultrasound analysis of the affected loops. Eur Radiol 2001; 11: 1423–8.
Ang A, Chong NK, Daneman A. Pediatric appendicitis in »real-time«: the value of sonography in diagnosis and treatment. Pediatr Emerg Care 2001; 17: 334–40.
Manner M, Stickel W. Diagnosis in suspected appendicitis. Can ultrasonography rule out acute appendicitis? Chirurg 2001; 72: 1036–42.
Jeffrey RB, Laing FC, Townsend RR. Acute appendicitis: sonographic criteria based upon 250 cases. Radiology 1988; 167: 327–9.
Puylaert JB. Ultrasound of appendicitis and its differential diagnosis. BerlinHeidelberg-New York: Springer, 1990: 118–8.
Sheridan MB, Nicholson DA, Martin DF. Transabdominal ultrasonography as the primary investigation in patients with suspected Crohn’s disease or recurrence: a prospective study. Clin Radiol 1993; 48: 402–4.
Hirche TO, Russler O, Schuessler G et al. The value of routinely performed ultrasonography in patients with Crohn disease. Scand J Gastroenterol 2002; 37: 1178–83.
Valette PJ, Rioux M, Pilleul F et al. Ultrasonography of chronic inflammatory bowel diseases. Eur Radiol 2001; 11: 1859–66.
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