The utility of sonographic signs to diagnose simple and complicated appendicitis in children

Abstract

Background: Appendicitis is one of the most common causes of acute abdominal pain in children, requiring accurate diagnosis to differentiate between simple and complicated cases for appropriate management. Ultrasound is a preferred imaging modality due to its non-invasive nature and absence of radiation. Objective: To assess the utility of specific sonographic signs in diagnosing simple and complicated appendicitis in pediatric patients. Methods: This retrospective study was conducted at Maternal and Child Birth hospital Najran City during period June 2023 to June 2024. Data were collected from 305 pediatric patients aged 2–18 years who underwent ultrasound for suspected appendicitis. Clinical presentations, laboratory results, and ultrasound findings, including appendiceal diameter, wall thickening, non-compressibility, peri-appendiceal fluid, echogenic fat, and appendicolith presence, were evaluated. Surgical or histopathological confirmation was used as the gold standard. Statistical measures, including sensitivity, specificity, and predictive values, were calculated. Results: Ultrasound demonstrated high diagnostic accuracy, with a sensitivity of 95% and specificity of 90%. Key signs for simple appendicitis included appendiceal diameter >6 mm (95%) and non-compressibility (94%). For complicated appendicitis, peri-appendiceal fluid (65%), echogenic fat (80%), and appendicolith (48%) were significant predictors. Abscess or perforation was observed in 66.7% of complicated cases and had a specificity of 100%. Conclusion: It is concluded that ultrasound is an effective diagnostic tool for identifying appendicitis in children and distinguishing between simple and complicated cases. Targeted use of sonographic signs can guide timely and appropriate management, improving outcomes in pediatric care.