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Apendiksin ultrasonografik sınıflamasına farklı bir bakış açısı

Yıl 2016, Cilt: 8 Sayı: 4, 207 - 213, 31.12.2016
https://doi.org/10.21601/ortadogutipdergisi.267262

Öz

Amaç: : Biz
bu çalışmada farklı lokalizasyonlardaki apendiksleri inceleyerek önceki
literatürden farklı bir sınıflama yapmayı ve böylece appendiksin sonografik
incelemesini kolaylaştırmayı amaçladık.

Materyal ve metod: Çalışma bizim departmanımıza pelvik veya batın
ultrasonografisi amacı ile başvuran 362 ardışık hasta üzerinde
gerçekleştirildi. Normal sonografik apendiks kriterleri maksimum çapı 6 mm
olan, komprese olan, kör sonlanan tübüler yapı olarak belirlendi. Appendiksler
ultrasonografi ile incelendi ve kaydedildi, referans çizgisi olarak da sağ
iliak fossadaki iliak damarlar alındı.

Bulgular: Apendiksler yerleşim yerine göre 1-8 sınıfa ayrıldı. Tip 1 iliak damarları geçen (85.5%),tip 2 iliak damarların
hemen yanında (2.41%), tip 3 çekumun
inferior ve lateralinde (1.93%), tip 4 sağ parakolik olukta (4.34%), tip 5
tamamen retroçekal (1.93%), tip 6 çekumun anteriorunda  (1.45%), tip 7 umblikusa uzanan (0.97%) and tip
8  çekal malpozisyonla birlikte
subhepatik yerleşim (1.45%).







Sonuç: Bu çalışmada literatürde daha önceden tanımlanandan
farklı olarak yeni bir sınıflama sistemi (1-8) ortaya konulmuştur. Normal ve
anormal apendikslerin en sık görülen yerleşimi iliak damarları geçen tip 1
olarak izlendi. İkinci en sık görülen yerleşim ise sağ parakolik olukta izlenen
tip 4 idi. İki farklı ilginç yerleşim ise umblikusa uzanan tip 7 ile subhepatik
alana uzanan tip8 idi.

Kaynakça

  • Aspelund G, Fingeret A, Gross E, et al. Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics 2014; 133: 586-593.
  • Old JL, Dusing RW, Yap W, Dirks J. Imaging for suspected appendicitis. Am Fam Physician 2005; 71: 71-78.
  • Baldisserotto M, Marchiori E. Accuracy of noncompressive sonography of children with appendicitis according to the potential positions of the appendix. AJR Am J Roentgenol 2000; 175: 1387-1392.
  • Incesu L, Coskun A, Selcuk MB, Akan H, Sozubir S, Bernay F. Acute appendicitis: MR imaging and sonographic correlation. AJR Am J Roentgenol 1997; 168: 669-674.
  • Rao PM, Rhea JT, Rattner DW, Venus LG, Novelline RA. Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann Surg 1999; 229: 344-349.
  • Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM. MR imaging evaluation of acute appendicitis in pregnancy. Radiology 2006; 238: 891-899.
  • Lehmann D, Uebel P, Weiss H, Fiedler L, Bersch W. Sonographic representation of the normal and acute inflamed appendix--in patients with right-sided abdominal pain. Ultraschall Med 2000; 21: 101-106.
  • Franke C, Böhner H, Yang Q, Ohmann C, Röher HD. Ultrasonography for diagnosis of acute appendicitis: results of a prospective multicenter trial. Acute Abdominal Pain Study Group. World J Surg 1999; 23: 141-146.
  • Bendeck SE, Nino-Murcia M, Berry GJ, Jeffrey RB Jr. Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology 2002; 225: 131-136.
  • Fujii Y, Hata J, Futagami K, et al. Ultrasonography improves diagnostic accuracy of acute appendicitis and provides cost savings to hospitals in Japan. J Ultrasound Med 2000; 19: 409-414.
  • Lane MJ, Liu DM, Huynh MD, Jeffrey RB Jr, Mindelzun RE, Katz DS. Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology 1999; 213(2): 341-346.
  • Gamanagatti S, Vashisht S, Kapoor A, Chumber S, Bal S. Comparison of graded compression ultrasonography and unenhanced spiral computed tomography in the diagnosis of acute appendicitis. Singapore Med J 2007; 48: 80-87.
  • Rioux M. Sonographic detection of the normal and abnormal appendix. AJR Am J Roentgenol 1992; 158: 773-778.
  • Zakaria O, Sultan TA, Khalil TH, Wahba T. Role of clinical judgment and tissue harmonic imaging ultrasonography in diagnosis of paediatric acute appendicitis. World J Emerg Surg 2011; 16;6:39.
  • Debnath J, Rajesh Kumar R, Mathur A. On the Role of Ultrasonography and CT Scan in the Diagnosis of Acute Appendicitis. Indian J Surg DOI 10.1007/s12262-012-0772-5.
  • Balthazar EJ1, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C. Acute appendicitis: CT and US correlation in 100 patients. Radiology 1994; 190: 31-35.
  • Himeno S, Yasuda S, Oida Y, et al. Ultrasonography for the diagnosis of acute appendicitis. Tokai J Exp Clin Med 2003; 28: 39-44.
  • Schwerk WB. Ultrasound first in acute appendix? Unnecessary laparotomies can often be avoided. MMW Fortschr Med 2000; 142: 29-32.
  • Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000; 215: 337-348.

A different view of the sonographic classification of the appendix

Yıl 2016, Cilt: 8 Sayı: 4, 207 - 213, 31.12.2016
https://doi.org/10.21601/ortadogutipdergisi.267262

Öz

Aim: We intended
to detect various appendix localisations with a classification system different
from those used in previous literature to facilitate the sonographic detection of
the appendix.

Patients and methods:
The study was performed on 362 consecutive
[.1]  patients who applied to our department for abdominal
or pelvic US examination to our department. The
sonographic criterion used to diagnose a normal appendix was visualization of
the full extension of a compressible, blind-ending tubular structure with a
maximum transverse diameter of 6 mm. Appendices were evaluated by US and localisations
were recorded and classified according to the reference line passing through
the iliac vessels

in the right
iliac fossa.

Results: Each appendix was classified as type 1 to 8 according to its location. Type 1 crossed the iliac vessels (85.5%), type 2 was medial to the iliac vessels
(2.41%), type 3 was inferior and
lateral to the cecum (1.93%), type
4 was in the right paracolic gutter (4.34%), type 5
was completely retrocecal (1.93%), type 6 was in front of the cecum (1.45%), type 7 extended to the umbilicus (0.97%) and type 8 was subhepatic with cecal
malposition (1.45%).

Conclusion: The study demonstrated a new classification system (types 1–8) different from those
described in previous literature. The most common position of the normal and
abnormal appendices in our study was crossing the iliac vessels (type 1). The second most common
position was the right paracolic gutter (type 4). Two interesting localisations extended to the umbilicus
(type 7) and appeared in the subhepatic space (type 8).
















 [.1]“Consequitive”
is not a word in English. The closest word is “consecutive,” which means in an
unbroken or logical sequence. That makes sense here, so I changed the spelling.
But please verify this change. 







Kaynakça

  • Aspelund G, Fingeret A, Gross E, et al. Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics 2014; 133: 586-593.
  • Old JL, Dusing RW, Yap W, Dirks J. Imaging for suspected appendicitis. Am Fam Physician 2005; 71: 71-78.
  • Baldisserotto M, Marchiori E. Accuracy of noncompressive sonography of children with appendicitis according to the potential positions of the appendix. AJR Am J Roentgenol 2000; 175: 1387-1392.
  • Incesu L, Coskun A, Selcuk MB, Akan H, Sozubir S, Bernay F. Acute appendicitis: MR imaging and sonographic correlation. AJR Am J Roentgenol 1997; 168: 669-674.
  • Rao PM, Rhea JT, Rattner DW, Venus LG, Novelline RA. Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann Surg 1999; 229: 344-349.
  • Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM. MR imaging evaluation of acute appendicitis in pregnancy. Radiology 2006; 238: 891-899.
  • Lehmann D, Uebel P, Weiss H, Fiedler L, Bersch W. Sonographic representation of the normal and acute inflamed appendix--in patients with right-sided abdominal pain. Ultraschall Med 2000; 21: 101-106.
  • Franke C, Böhner H, Yang Q, Ohmann C, Röher HD. Ultrasonography for diagnosis of acute appendicitis: results of a prospective multicenter trial. Acute Abdominal Pain Study Group. World J Surg 1999; 23: 141-146.
  • Bendeck SE, Nino-Murcia M, Berry GJ, Jeffrey RB Jr. Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology 2002; 225: 131-136.
  • Fujii Y, Hata J, Futagami K, et al. Ultrasonography improves diagnostic accuracy of acute appendicitis and provides cost savings to hospitals in Japan. J Ultrasound Med 2000; 19: 409-414.
  • Lane MJ, Liu DM, Huynh MD, Jeffrey RB Jr, Mindelzun RE, Katz DS. Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology 1999; 213(2): 341-346.
  • Gamanagatti S, Vashisht S, Kapoor A, Chumber S, Bal S. Comparison of graded compression ultrasonography and unenhanced spiral computed tomography in the diagnosis of acute appendicitis. Singapore Med J 2007; 48: 80-87.
  • Rioux M. Sonographic detection of the normal and abnormal appendix. AJR Am J Roentgenol 1992; 158: 773-778.
  • Zakaria O, Sultan TA, Khalil TH, Wahba T. Role of clinical judgment and tissue harmonic imaging ultrasonography in diagnosis of paediatric acute appendicitis. World J Emerg Surg 2011; 16;6:39.
  • Debnath J, Rajesh Kumar R, Mathur A. On the Role of Ultrasonography and CT Scan in the Diagnosis of Acute Appendicitis. Indian J Surg DOI 10.1007/s12262-012-0772-5.
  • Balthazar EJ1, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C. Acute appendicitis: CT and US correlation in 100 patients. Radiology 1994; 190: 31-35.
  • Himeno S, Yasuda S, Oida Y, et al. Ultrasonography for the diagnosis of acute appendicitis. Tokai J Exp Clin Med 2003; 28: 39-44.
  • Schwerk WB. Ultrasound first in acute appendix? Unnecessary laparotomies can often be avoided. MMW Fortschr Med 2000; 142: 29-32.
  • Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000; 215: 337-348.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma makaleleri
Yazarlar

MİKAİL İnal

Birsen Ünal Daphan

M. Yasemin Karadeniz Bilgili )

Yayımlanma Tarihi 31 Aralık 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 8 Sayı: 4

Kaynak Göster

Vancouver İnal M, Daphan BÜ, Bilgili ) MYK. Apendiksin ultrasonografik sınıflamasına farklı bir bakış açısı. otd. 2016;8(4):207-13.

e-ISSN: 2548-0251

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