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Sonography of acute appendicitis in childhood: perforation versus nonperforation

We evaluated the sonographic findings in 133 consecutive children referred for suspected appendicitis. Fifty‐eight of these patients (44%) ultimately underwent surgery, with 54 of these proved to have acute appendicitis. Thirty‐one (58%) of the 54 had nonperforated appendicitis, and 23 (43%) had evidence of perforation. Previously described sonographic findings that have been employed in the diagnosis of appendicitis were evaluated, with the presence or absence of these findings being compared in patients with non‐perforated and perforated appendicitis. In those patients who did not undergo surgery, the following findings were documented and compared to the findings in patients with proved appendicitis: (1) an identifiable appendix and its sonographic characteristics, (2) fluid localized to the right peritoneal reflection or periappendiceal region, or both, (3) free pelvic fluid, and (4) right lower quadrant adenopathy. Our results suggest that high‐resolution, real‐time sonography, using graded compression, is very sensitive in the identification of acute nonperforated appendicitis. Perforated appendicitis, however, can be a more difficult diagnosis because the appendix frequently decompresses with perforation and yet may not "wall off" or form a well‐defined abscess. As a result, the appendix can be very difficult to identify.