VALUE OF ULTRASOUND IN DIAGNOSIS OF DISEASES IN ILEOCECAL REGION
Abstract
Background. Frequent clinical diagnosis of diseases in ileocecal region is inconclusive and increases with age. Graded compression ultrasonography (US) improves diagnostic accuracy of acute appendicitis but it may be more difficult to carry out in adult patients and other diseases are more frequently in them. The author’s own experience in sonography of the ileocecal region is presented in this study.
Methods. 44 patients (15 m., 29 f., 11–76 y., mean 34.4 y.) with acute right lower abdominal pain (37) or with persistent pain after abdominal surgery (7) in the period from January 2000 to November 2002 were included in this study. Graded compression with convex 3.5 MHz and with linear 7.5 MHz probe on grayscale and Color Doppler sonography was performed. The results of US were correlated with operative findings (all appendicitisses, abscesses, mesenterial pseudocyst and malignancies) or with follow up (other).
Results. In 11/12 (91.7%) of patients with later surgically proved appendicitis, US diagnosed it (6 without / 5 with signs of perforation and abscess). In two patients it was false positive, but in one of them operation was justified because of other pathology. In 14/37 (37.8%) of patients with indeterminate right lower abdominal pain, US diagnosed it (10) or proved (4) some other diseases such as Crohn’s disease (3), mesenteric lymphadenitis (2), infectious ileocecitis (3), ovarian tumour (1), adnexitis (1), myoma in the right part of the uterus (1) and cecal cancer (3). In 10/37 (27%) of patients a disease in ileocecal region was excluded. US falsely diagnosed appendicitis in one of these patients. In 4/7 of operated patients abscesses were found while in others abdominal wall seroma (1), Crohn’s disease (1) and adnexitis (1). Diagnostic value of US in ileocecal region: sensitivity – 0.97, specificity – 0.90.
Conclusions. US is an accurate method in diagnosis of diseases in ileocecal region if graded compression with convex and high frequency linear probe on gray scale and color Doppler is performed. Because the preparation of patient is not necessary, it is regarded as appropriate method in diagnosis of acute ileocecal pathology.
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