Purpose or Case Report: Development of complications in patients treated for acute appendicitis is not rare. Some authors have advocated the important role of CT in this clinical setting. Increased awareness of radiation-related safety issues in the past years has brought focus on the role and safety of ultrasound (US) to diagnose acute appendicitis in children. However, no study has specifically addressed the role of US for assessment of complications in children operated for acute appendicitis. Our purpose is to evaluate if US is an accurate and safe imaging modality in this setting.
Methods & Materials: Children who had US for suspected post-operative complications within 3 months after surgery for acute appendicitis (pathology-proven) in our hospital, from January 2014 to December 2015, were included in this retrospective study. Pre and postoperative imaging studies (all modalities) were reviewed and imaging findings were recorded. Relevant demographical, clinical and laboratory data were also recorded. To assess the safety of US in assessing postoperative complications, the short (2 weeks) and long-term (up to 90 days) outcomes were studied by reviewing the subsequent consultations or follow-up visit notes and recording any symptoms or signs of complications, and also by comparing with CT findings if available. This study was approved by our institutional Research Ethic Board.
Results: During the study period there were 565 appendectomies for pathology-proven acute appendicitis. Of these, 112 patients (69 males; mean age 8y9m; age range 2y-18y) had a postoperative US (mean 2 studies), with the first performed on average 10.7 days after the surgery. Postoperative US was positive in 67 patients, showing intra-abdominal collections in 62 (1-9 collections; mean 1), abdominal wall collections in 5 and signs of bowel obstruction in 3. Postoperative CT was done in 4 patients who also had initial postoperative US, showing intra-abdominal fluid collections in all 4. In 2 patients, 1 additional collection not seen on US was shown on CT, but this did not impact management. CT showed signs of bowel obstruction in 1 patient, not recognized on US. In the 45 patients with negative postoperative US, follow-up clinical evolution showed no adverse events to suggest missed pathology. The last follow-up visit was on average 90 days after surgery.
Conclusions: Ultrasound is a relatively accurate and safe imaging modality to assess for postoperative complications in children after surgery for acute appendicitis and could limit the use of CT.