Role of Doppler in Predicting the Complicated and Impending to Complicate Cases of Acute Appendicitis

Abstract

Introduction: Acute appendicitis is one of the most common emergency surgical problems which could result due to obstructive or non-obstructive causes. The obstructive type progresses fast and could result in complications like gangrene formation and perforation frequently than the non-obstructive type. Uncomplicated cases of appendicitis can be managed conservatively, however complicated and impending to complicate cases need emergency surgical intervention to reduce the morbidity and mortality rates. Though, with pre-operative sonography, which is the principle imaging modality used for the differentiation between the complicated or uncomplicated type of appendicitis is possible, it is still challenging to find the cases that are impending to complicate. Aim: To assess the role of Doppler study in differentiating the uncomplicated, complicated and impending to complicate cases among acute appendicitis patients. Materials and Methods: Total 70 patients were included in the study who showed features of acute appendicitis on ultrasonography gray scale imaging and both color and power Doppler imaging was done in all these patients. Out of these 70 patients, 48 patients who had post-operative confirmative histopathological report were divided into Group-I - Uncomplicated appendicitis with non-obstructive cause (n- 13); Group-II - Impending to complicate cases with obstructive or non-obstructive cause (n-28); and Group-III -Complicated appendicitis (n-7) like perforated appendix, appendicular abscess/mass. In all three groups histo-pathological findings correlation with imaging findings of both color and power Doppler was done. Vascularity was considered circumferential when the flow was evenly distributed around the walls of the inflamed appendix, while it was considered patchy in few uneven specks of flow. Results: The flow was detectable in all the 48 patients on power Doppler study, however only (n-43) patients were showing flow on color Doppler study. Patchy and circumferential pattern of flow seen in 15.4% and 76.9% of cases on color Doppler and 23.1% and 76.9%of cases on power Doppler respectively in Group-I (n- 13). In 82.1% and 7.1% of cases on color Doppler and 92.9% and 7.1% of cases on power Doppler respectively in Group-II - (n-28). In 57.1% and 28.6% on color Doppler and 71.4% and 28.6% on power Doppler respectively in Group–III (n-7). For color Doppler results the p-value was <0.0001 and for power Doppler results the p-value was <0.0001. Conclusion: We found that the presence and pattern of flow on Doppler study has an add-on value in diagnosing acute appendicitis along with gray scale USG. The pattern of flow in appendicular wall on both color and power Doppler imaging can be applied to find the acute appendicitis cases that are impending to complicate. Power Doppler will be of help in patients in whom color Doppler study shows negative results

Keywords

• appendicular mass
• color doppler
• non-obstructive
• obstructive
• power doppler