Appendix ultrasound is performed if acute or chronic appendicitis is suspected. It is performed without preparation in the supine position. In the presence of clearly localized pain, the patient himself installs the sensor in the area of greatest pain. In case of pain syndrome without a clear localization, the doctor performs sonography taking into account the probability of different variants of the location of the appendix, starting with a typical localization in the lower abdominal quadrant. If the results are questionable, the study is repeated after emptying the bladder or after 30 minutes.
Ultrasound is performed when acute or chronic appendicitis is suspected in doubtful cases, when clinical data do not allow unambiguous diagnosis of pathology. All or several of the following symptoms are considered as indications:
- any vague abdominal pain that has a constant increasing character increases with movements;
- tension of the muscles of the anterior abdominal wall;
- increase in body temperature;
- nausea, vomiting, diarrhea, frequent urge to stool;
- dry tongue.
Usually, appendicitis pains are localized in the lower right corner of the abdomen, however, due to the variability of the location of the appendix, they may occur in other places (along the midline, closer to the epigastrium, in the left half of the abdomen). Atypical cases of the location of the appendix create the greatest difficulties in diagnosis, therefore, ultrasound is more often shown to such patients.
The procedure is harmless, has no contraindications, can be prescribed to children and women during pregnancy. The only limitation to performing appendix ultrasound is the serious condition of the patient, requiring immediate surgical intervention or resuscitation.
In case of emergency admission of the patient, appendix ultrasound is performed without preparation. The planned examination is carried out after the following preparatory measures:
- refusal of products that contribute to increased gas formation for 2 days;
- abstinence from eating on the day of the examination;
- refusal to drink water, smoking immediately before the procedure.
Methodology of conducting
The subject is laid on his back, the stomach is freed from clothes. If the patient can clearly indicate where it hurts, he himself installs the sensor at the most painful point. With fuzzy localization of pain, the doctor alternately examines different areas of the abdomen, taking into account the probability of the location of the appendix. When studying the painful area, the specialist presses the sensor on the anterior abdominal wall, which allows you to push back the gas, push back the intestinal loops, reduce the distance between the sensor and the vermiform process. The duration of ultrasound is 5-7 minutes.
Interpretation of results
A healthy appendix is a multilayer tube with a diameter of up to 6 mm and a wall thickness of up to 3 mm. The length of the vermiform process varies significantly. The walls of the normal appendix are not spasmodic, ultrasound reveals peristaltic waves synchronous with the peristalsis of the adjacent part of the intestine.
With inflammation, the walls thicken, become heterogeneous, bumpy. The process has a circular cross-section, does not shrink. The walls of the appendix are spasmed, the lumen of the organ is enlarged. With phlegmonous appendicitis, the wall layering is preserved, blood flow is increased. With gangrenous form, the layering is broken, the blood flow is fragmented. The presence of an anechoic rim according to ultrasound data indicates the accumulation of exudate.
After appendix ultrasound
In the absence of pathology, the patient is allowed to go home, there are no restrictions, complications do not develop. If acute appendicitis is detected, the patient is urgently hospitalized, an open or laparoscopic appendectomy is performed. The chronic form of appendicitis with mild symptoms requires conservative treatment, with severe pain syndrome – operative.