Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Computed Tomography Trend in Acute Appendicitis: Retrospective Cross-Sectional Analysis
Akut Apandisitte Bilgisayarlı Tomografi Eğilimi: Retrospektif Kesitsel Analiz
Salih TUNCALa, Yılmaz ÜNALa
aDepartment of General Surgery, University of Health Sciences Ankara Training and Research Hospital, Ankara, Türkiye
Turkiye Klinikleri J Med Sci. 2022;42(2):111-8
doi: 10.5336/medsci.2021-85007
Article Language: EN
Full Text
ABSTRACT
Objective: Acute appendicitis (AA) is one of the abdominal pain pathologies that often requires emergency surgery. It was aimed to reveal the flaws in our radiological examination request algorithm by looking at the diagnostic activities of abdominal ultrasonography (USG) and computed tomography (CT). Material and Methods: Hospital records of 299 patients who were operated between January and July 2019 in Ankara Training and Research Hospital, General Surgery Clinic were retrospectively reviewed. Patients' age, gender, comorbid disease, body mass index, preoperative white blood leukocyte levels, length of hospital stay and CT and USG requests were recorded. Findings were correlated with postoperative pathology results and the efficacy of radiological examinations in diagnosis were evaluated. Results: The patients were classified as those who underwent USG only (85), CT only (43), CT after USG (162) and those who did not undergo imaging (9). Pathology results were reported as apendicitis in 257 patients (86%) and normal in 42 (%14). When radiological imaging examinations and pathology results were compared, positive predictive values/occuracy rates for USG alone, only CT and CT after USG were 89.02%/89.41%, 94.12%/76.74% and 87.97%/78.40% respectively. Although the positive predictive value of CT was higher than USG, the occuracy rate was lower. No statistically significant difference was found between the groups in terms of pathological correlation. Conclusion: In patients with AA, it is appropriate to make CT requests with the recommendation of a radiologist and surgeon after the first examination and sonographic examination. Thus, we believe that CT will be used effectively and there will be no unnecessary X-ray burden for patients.

Keywords: Appendicitis; tomography; ultrasonography
ÖZET
Amaç: Akut apandisit (AA), sıklıkla acil cerrahi gerektiren karın ağrısı patolojilerinden biridir. Karın ultrasonografisi (USG) ve bilgisayarlı tomografinin (BT) tanısal aktivitelerine bakılarak, radyolojik tetkik istem algoritmamızdaki aksaklıkların ortaya çıkarılması amaçlandı. Gereç ve Yöntemler: Ocak-Temmuz 2019 tarihleri arasında Ankara Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniğinde ameliyat edilen 299 hastanın hastane kayıtları geriye dönük olarak incelendi. Hastaların yaş, cinsiyet, komorbid hastalığı, beden kitle indeksi, ameliyat öncesi lökosit düzeyleri, hastanede kalış süreleri, BT ve USG istekleri kaydedildi. Bulgular, postoperatif patoloji sonuçları ile korele edildi ve radyolojik incelemelerin tanıdaki etkinlikleri değerlendirildi. Bulgular: Hastalar; sadece USG (85), sadece BT (43), USG sonrası BT (162) yapılanlar ve görüntüleme yapılmayanlar (9) olarak klasifiye edildi. Patoloji sonuçları, hastaların 257'sinde (%86) apandisit, 42'sinde (%14) normal olarak rapor edildi. Radyolojik görüntüleme incelemeleri ve patoloji sonuçları karşılaştırıldığında; USG, BT ve USG sonrası BT yapılan hastalarda pozitif prediktif değerler/geçerlilik oranları sırasıyla %89,02/%89,41; %94,12/%76,74 ve %87,97/%78,40 idi. BT'nin pozitif prediktif değeri, USG'ye göre daha yüksek olmasına rağmen geçerlilik oranı daha düşüktü. Patolojik korelasyon açısından gruplar arasında istatistiksel olarak anlamlı fark bulunmadı. Sonuç: AA hastalarında ilk muayene ve sonografik inceleme sonrasında BT istemlerinin radyolog ve cerrah önerisi ile yapılması uygundur. Böylece BT'nin etkin kullanılacağı ve hastalar için gereksiz X-ışını yükü olmayacağı kanaatindeyiz.

Anahtar Kelimeler: Apandisit; tomografi; ultrasonografi
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