Diagnostic accuracy of ultrasound in the paediatric population with acute right iliac fossa pain, our District General Hospital experience.

AIM: This project aimed to evaluate the role of ultrasound scan (USS) in children presenting with acute onset right iliac fossa (RIF) pain and suspected appendicitis.

METHODS

We retrospectively studied 100 consecutive children undergoing USS for RIF pain. Children with low to moderate clinical probability of appendicitis were seen by the surgical team and subsequently underwent USS by a radiologist or a sonographer with a special interest in paediatric USS. The clinical findings, blood tests, and radiological diagnosis led to a decision to operate, observe or discharge. USS findings were subsequently verified with the final histology. The six-month follow-up data of these patients were also analysed.

RESULTS

35 males, median age of 11 years (range 4-17), and 65 females, median age of 14 years (range 6-18) were included. A total of 23 appendicectomies were performed. On histology appendicitis was confirmed in 20, including 16 pre-operatively diagnosed on USS. 6 of these appendicectomies were performed on clinical suspicion with normal USS. 1 patient was diagnosed with neuroendocrine tumour of the appendix. Only 2 negative appendicectomies were performed. 62 patients were discharged without intervention. USS sensitivity was 74%, and specificity was 92% for appendicitis. An additional 16 patients were identified with alternate pathology including 5 ovarian cysts.

CONCLUSION

Appendicitis was more common in male patients; however, there was no difference in overall disease prevalence in male or female paediatric patients. Thus, USS is a valuable tool to exclude appendicitis in children with low to moderate probability.