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Erschienen in: Pediatric Radiology 9/2009

01.09.2009 | Original Article

Sonographic findings following appendectomy for uncomplicated appendicitis in children

verfasst von: Francis Serour, Amir Herman, Michaela Witzling, Arkadi Gorenstein, llan Dalal

Erschienen in: Pediatric Radiology | Ausgabe 9/2009

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Abstract

Background

Little is known about ‘normal’ local sonographic changes occurring in the postoperative period after an uneventful appendectomy.

Objective

To analyse the local changes on US examination occurring after uneventful open (OA) or laparoscopic (LA) appendectomy in children with normal histology and with nonperforated acute appendicitis.

Materials and methods

US was prospectively performed in 82 children (54 boys and 28 girls) aged 1–16 years (mean 11.6±3.2 years), 3 days following LA (n=51, 62%) or OA (n=31, 38%) for nonperforated appendicitis. Multivariate analysis was performed using stepwise logistic regression, with the following starting variables: surgical technique, gender, pathological finding, appendix location, and histology.

Results

Of the 82 patients, 35 (42.7%) had postoperative pathological US findings such as peritoneal fluid, oedematous mesenteric fat and thickening of the bowel wall. While the overall incidence of pathological US findings between OA and LA groups was not significantly different, multivariate logistic regression analysis showed that OA is associated with a reduction by a factor of 0.35 in the odds ratio of postoperative pathological US findings (P=0.007).

Conclusion

Pathological US findings are common in children after appendectomy, particularly after LA. Awareness of these pathological findings might prevent unnecessary postoperative treatment.
Literatur
1.
Zurück zum Zitat Wong ML, Casey SO, Leonidas JC et al (1994) Sonographic diagnosis of acute appendicitis in children. J Pediatr Surg 29:1356–1360PubMedCrossRef Wong ML, Casey SO, Leonidas JC et al (1994) Sonographic diagnosis of acute appendicitis in children. J Pediatr Surg 29:1356–1360PubMedCrossRef
2.
Zurück zum Zitat Vasavada P (2004) Ultrasound evaluation of acute abdominal emergencies in infants and children. Radiol Clin North Am 42:445–456PubMedCrossRef Vasavada P (2004) Ultrasound evaluation of acute abdominal emergencies in infants and children. Radiol Clin North Am 42:445–456PubMedCrossRef
3.
Zurück zum Zitat Sivit CJ, Applegate KE (2003) Imaging of acute appendicitis in children. Semin Ultrasound CT MR 24:74–82PubMedCrossRef Sivit CJ, Applegate KE (2003) Imaging of acute appendicitis in children. Semin Ultrasound CT MR 24:74–82PubMedCrossRef
4.
Zurück zum Zitat Peletti AB, Baldisserotto M (2006) Optimizing US examination to detect the normal and abnormal appendix in children. Pediatr Radiol 36:1171–1176PubMedCrossRef Peletti AB, Baldisserotto M (2006) Optimizing US examination to detect the normal and abnormal appendix in children. Pediatr Radiol 36:1171–1176PubMedCrossRef
5.
Zurück zum Zitat Baker DE, Silver TM, Coran AG et al (1986) Postappendectomy fluid collections in children: incidence, nature, and evolution evaluated using US. Radiology 161:341–344PubMed Baker DE, Silver TM, Coran AG et al (1986) Postappendectomy fluid collections in children: incidence, nature, and evolution evaluated using US. Radiology 161:341–344PubMed
6.
Zurück zum Zitat Gorenstein A, Gewurtz G, Serour F et al (1994) Postappendectomy intra-abdominal abscess: a therapeutic approach. Arch Dis Child 70:400–402PubMedCrossRef Gorenstein A, Gewurtz G, Serour F et al (1994) Postappendectomy intra-abdominal abscess: a therapeutic approach. Arch Dis Child 70:400–402PubMedCrossRef
7.
Zurück zum Zitat Aveline B, Guimaraes R, Bely N et al (1993) lntraabdominal serous fluid collections after appendectomy: a normal sonographic finding. AJR 161:71–73PubMed Aveline B, Guimaraes R, Bely N et al (1993) lntraabdominal serous fluid collections after appendectomy: a normal sonographic finding. AJR 161:71–73PubMed
8.
Zurück zum Zitat Neff CC, Simeone JF, Ferrucci JT Jr (1983) The occurrence of fluid collections following routine abdominal surgical procedures: sonographic survey in asymptomatic postoperative patients. Radiology 146:463–466PubMed Neff CC, Simeone JF, Ferrucci JT Jr (1983) The occurrence of fluid collections following routine abdominal surgical procedures: sonographic survey in asymptomatic postoperative patients. Radiology 146:463–466PubMed
9.
Zurück zum Zitat Ignacio RC, Burke R, Spencer D et al (2004) Laparoscopic versus open appendectomy: what is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc 18:334–337PubMedCrossRef Ignacio RC, Burke R, Spencer D et al (2004) Laparoscopic versus open appendectomy: what is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc 18:334–337PubMedCrossRef
10.
Zurück zum Zitat Oka T, Kurkchubasche AG, Bussey JG (2004) Open and laparoscopic appendectomy are equally safe and acceptable in children. Surg Endosc 18:242–245PubMedCrossRef Oka T, Kurkchubasche AG, Bussey JG (2004) Open and laparoscopic appendectomy are equally safe and acceptable in children. Surg Endosc 18:242–245PubMedCrossRef
11.
Zurück zum Zitat Sauerland S, Lefering R, Neugebauer EAM (2004) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Systematic Reviews, Issue 4. Art. no. CD001546. doi:10.1002/14651858.CD001546.pub2 Sauerland S, Lefering R, Neugebauer EAM (2004) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Systematic Reviews, Issue 4. Art. no. CD001546. doi:10.​1002/​14651858.​CD001546.​pub2
12.
Zurück zum Zitat Neuhaus SJ, Watson DI (2004) Pneumoperitoneum and peritoneal surface changes. A review. Surg Endosc 18:1316–1322PubMedCrossRef Neuhaus SJ, Watson DI (2004) Pneumoperitoneum and peritoneal surface changes. A review. Surg Endosc 18:1316–1322PubMedCrossRef
13.
Zurück zum Zitat Serour F, Witzling M, Gorenstein A (2005) Is laparoscopic appendectomy in children associated with an uncommon postoperative complication? Surg Endosc 19:919–922PubMedCrossRef Serour F, Witzling M, Gorenstein A (2005) Is laparoscopic appendectomy in children associated with an uncommon postoperative complication? Surg Endosc 19:919–922PubMedCrossRef
14.
Zurück zum Zitat Reid RI, Dobbs BR, Frizelle FA (1999) Risk factors for post-appendicectomy intra-abdominal abscess. Aust N Z J Surg 69:373–374PubMedCrossRef Reid RI, Dobbs BR, Frizelle FA (1999) Risk factors for post-appendicectomy intra-abdominal abscess. Aust N Z J Surg 69:373–374PubMedCrossRef
15.
Zurück zum Zitat Ein S, Wales P, Langer JC et al (2008) Is there a role for routine abdominal imaging in predicting postoperative intraabdominal abscess formation after appendectomy for pediatric ruptured appendix? Pediatr Surg Int 24:307–309PubMedCrossRef Ein S, Wales P, Langer JC et al (2008) Is there a role for routine abdominal imaging in predicting postoperative intraabdominal abscess formation after appendectomy for pediatric ruptured appendix? Pediatr Surg Int 24:307–309PubMedCrossRef
16.
Zurück zum Zitat Paik PS, Towson JA, Anthone GJ et al (1997) Intra-abdominal abscesses following laparoscopic and open appendectomies. J Gastrointest Surg 1:188–193PubMedCrossRef Paik PS, Towson JA, Anthone GJ et al (1997) Intra-abdominal abscesses following laparoscopic and open appendectomies. J Gastrointest Surg 1:188–193PubMedCrossRef
17.
Zurück zum Zitat Horwitz JR, Custer MD, May BH et al (1997) Should laparoscopic appendectomy be avoided for complicated appendicitis in children? J Pediatr Surg 32:1601–1603PubMedCrossRef Horwitz JR, Custer MD, May BH et al (1997) Should laparoscopic appendectomy be avoided for complicated appendicitis in children? J Pediatr Surg 32:1601–1603PubMedCrossRef
18.
Zurück zum Zitat Krisher SL, Browne A, Dibbins A et al (2001) Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 136:438–441PubMedCrossRef Krisher SL, Browne A, Dibbins A et al (2001) Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 136:438–441PubMedCrossRef
19.
Zurück zum Zitat Kouwenhoven EA, Repelaer van Driel OJ, van Erp WF (2005) Fear for the intraabdominal abscess after laparoscopic appendectomy: not realistic. Surg Endosc 19:923–926PubMedCrossRef Kouwenhoven EA, Repelaer van Driel OJ, van Erp WF (2005) Fear for the intraabdominal abscess after laparoscopic appendectomy: not realistic. Surg Endosc 19:923–926PubMedCrossRef
20.
Zurück zum Zitat McKinlay R, Neeleman S, Klein R et al (2003) Intraabdominal abscess following open and laparoscopic appendectomy in the pediatric population. Surg Endosc 17:730–733PubMedCrossRef McKinlay R, Neeleman S, Klein R et al (2003) Intraabdominal abscess following open and laparoscopic appendectomy in the pediatric population. Surg Endosc 17:730–733PubMedCrossRef
21.
Zurück zum Zitat Moraitis D, Kini SU, Annamaneni RK (2004) Laparoscopy in complicated pediatric appendicitis. JSLS 8:310–313PubMed Moraitis D, Kini SU, Annamaneni RK (2004) Laparoscopy in complicated pediatric appendicitis. JSLS 8:310–313PubMed
22.
Zurück zum Zitat Ikeda H, Ishimaru Y, Takayasu H et al (2004) Laparoscopic versus open appendectomy in children with uncomplicated and complicated appendicitis. J Pediatr Surg 39:1680–1685PubMedCrossRef Ikeda H, Ishimaru Y, Takayasu H et al (2004) Laparoscopic versus open appendectomy in children with uncomplicated and complicated appendicitis. J Pediatr Surg 39:1680–1685PubMedCrossRef
23.
Zurück zum Zitat Volz J, Koster S, Spacek Z et al (1999) Characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum. Surg Endosc 13:611–614PubMedCrossRef Volz J, Koster S, Spacek Z et al (1999) Characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum. Surg Endosc 13:611–614PubMedCrossRef
24.
Zurück zum Zitat Bloechle C, Kluth D, Holstein AF et al (1999) A pneumoperitoneum perpetuates severe damage to the ultrastructural integrity of parietal peritoneum in gastric perforation-induced peritonitis in rats. Surg Endosc 13:683–688PubMedCrossRef Bloechle C, Kluth D, Holstein AF et al (1999) A pneumoperitoneum perpetuates severe damage to the ultrastructural integrity of parietal peritoneum in gastric perforation-induced peritonitis in rats. Surg Endosc 13:683–688PubMedCrossRef
25.
Zurück zum Zitat Rosário MT, Ribeiro U Jr, Corbett CE et al (2006) Does CO2 pneumoperitoneum alter the ultra-structure of the mesothelium? J Surg Res 133:84–88PubMedCrossRef Rosário MT, Ribeiro U Jr, Corbett CE et al (2006) Does CO2 pneumoperitoneum alter the ultra-structure of the mesothelium? J Surg Res 133:84–88PubMedCrossRef
26.
Zurück zum Zitat Bergström M, Falk P, Park PO et al (2008) Peritoneal and systemic pH during pneumoperitoneum with CO2 and helium in a pig model. Surg Endosc 22:359–364PubMedCrossRef Bergström M, Falk P, Park PO et al (2008) Peritoneal and systemic pH during pneumoperitoneum with CO2 and helium in a pig model. Surg Endosc 22:359–364PubMedCrossRef
Metadaten
Titel
Sonographic findings following appendectomy for uncomplicated appendicitis in children
verfasst von
Francis Serour
Amir Herman
Michaela Witzling
Arkadi Gorenstein
llan Dalal
Publikationsdatum
01.09.2009
Verlag
Springer-Verlag
Erschienen in
Pediatric Radiology / Ausgabe 9/2009
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-009-1301-y

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