The Benefit of Routine Abdominal Echo for Acute Abdominal Pain of the Right Lower Quadrant with Suggested Appendicitis

Abstract

Background: Acute abdominal pain with equivocal clinical examination is still a great challenge for emergency physicians. The aim of this study was to determine whether routine abdominal echo is helpful in the differential diagnosis for acute abdominal pain of the right lower quadrant (RLQ) with or without typical symptoms and signs of appendicitis in the emergency department. Methods: A total of 55 adult patients with suggested appendicitis underwent ultrasonography of the RLQ. Patients with symptoms and signs of appendicitis (migratory pain, localized and rebounding tenderness over McBurney's point, and leukocytosis with left shift, and plain abdominal radiography showing ileus located in the RLQ or appendiceal fecalith) were defined as typical; the other patients admitted had equivocal signs and symptoms of acute appendicitis which were atypical. Pediatric patients (age was less than 15 years old) and pregnant patients were not included in this study. Patients without complete examination results were excluded from our study. Thirty-five patients had typical symptoms and signs of appendicitis; 20 patients presented with equivocal symptoms and signs of appendicitis. The SPSS statistical programs packages were used for the statistical analysis. Differences were regarded as statistically significant when p＜0.05. Results: Thirty-five patients had typical symptoms and signs of appendicitis. Thirty-one of the 35 patients had positive signs on ultrasonography. Twenty patients did not have typical symptoms and signs of appendicitis and they were individually analyzed: three patients had right side hydronephrosis, three had gynecological problems (endometriosis, ovarian cyst rupture, and ovarian cyst torsion), two had dilated blind-end loop with target images, as well as appendicitis proven by appendectomy, and one had a cecal tumor. The ultrasonographic findings of the remaining patients (11 patients) showed normal images or much bowel gas, and four of them underwent surgery for appendicitis. The use of abdominal echo alone was of limited benefit in detecting true appendicitis in patients with atypical symptoms and signs of appendicitis (p＞0.05). However, it was a valuable tool in performing differential diagnosis. Conclusion: Routine abdominal echo performed by gastroenterologists or trained physicians is a useful tool in the differential diagnosis of patients with acute pain of the RLQ and without typical symptoms and signs of appendicitis.