Ulus Travma Acil Cerrahi Derg. 2022; 28(4): 428-433 | DOI: 10.14744/tjtes.2020.58991

Akut apandisitli hastalarda perforasyonu belirlemek için periton kalýnlaþmasý ve kontrastlanmasý kullanýlabilir mi?

Mehmet Tahtabaþý¹, Sadettin Er², Þükrü Mehmet Ertürk^3
1Saðlýk Bilimleri Üniversitesi, Somali Türkiye Recep Tayyip Erdoðan Eðitim ve Araþtýrma Hastanesi, Radyoloji Anabilim Dalý, Mogadishu-Somali
²Saðlýk Bilimleri Üniversitesi, Somali Türkiye Recep Tayyip Erdoðan Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Anabilim Dalý, Mogadishu-Somali
³Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi, Radyoloji Anabilim Dalý, Ýstanbul

AMAÇ: Akut apandisit (AA) geliþmiþ ülkelerde karýn aðrýsýnýn en sýk nedenlerinden biridir. Bu çalýþmada, perfore olan ve perfore olmayan apandisitin ayrýmýnda yaþ, laboratuvar ve spesifik bilgisayarlý tomografi (BT) bulgularýnýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Somali Türkiye Recep Tayyip Erdoðan Eðitim ve Araþtýrma Hastanesinde, Kasým 2015 ile Aralýk 2019 tarihleri arasýnda, AA ta-nýsý alan ve apendektomi ameliyatý yapýlan 252 hastayý geriye dönük olarak inceledik. Ameliyat öncesi uygun protokolle çekilmiþ BT’si bulunmayanlar ve 18 yaþ altý hastalar çalýþma dýþý býrakýldý. Hastalar histopatoloji sonucuna göre; perfore apandisit (Grup-1) ve perfore olmayan apandisit (Grup-2) olmak üzere ikiye ayrýldý. Tüm hastalarýn demografik, laboratuvar, BT bulgularý ve patoloji verileri deðerlendirildi.
BULGULAR: Bu çalýþmaya 80 hasta dahil edildi. Hastalarýn %40’ý (n=32) perfore apandisit (Grup-1) ve %60’ý (n=48) perfore olmayan apandisit (Grup-2) olarak sýnýflandýrýldý. Grup-1’de C-reaktif protein deðeri Grup-2’ye kýyasla istatistiksel olarak daha yüksek bulundu (sýrasýyla; 177.5±118.9 ve 100.2±87.3 mg/L; p=0.001). Tek deðiþkenli analizde; apendiks lümen çapý (p=0.002), apendiks duvar defekti (p<0.001), peritoneal kalýnlaþma ve kontrastlanma (p<0.001), asit (p=0.031), intraabdominal apse (p=0.003), jejunal kalýnlaþma (p=0.019), ileal kalýnlaþma (p=0.008) ve ileus (p=0.035) Grup-1’de Grup-2’ye kýyasla istatistiksel olarak daha yüksek bulundu. Tek deðiþkenli analizde istatistiksel olarak anlamlý verilerle yapýlan binominal lojistik regresyon analizinde; apendiks duvar defekti (OR: 0.069, %95 CI=0.014–0.327, p=0.001), peritoneal kalýnlaþma ve kontrastlanma (OR: 0.131, %95 CI=0.024–0.714, p=0.019) perfore apandisit için baðýmsýz deðiþkenler olarak belirlendi.
TARTIÞMA: Bilgisayarlý tomografi bulgularý arasýnda apendiks duvar defekti, peritoneal kalýnlaþma ve kontrastlanma perforasyonun saptanmasýnda önemli bir role sahiptir.

Anahtar Kelimeler: Akut apandisit, bilgisayarlý tomografi, perforasyon; peritoneal kalýnlaþma ve kontrastlanma.

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Can peritoneal thickening and enhancement be used to determine perforation in patients with acute appendicitis?

Mehmet Tahtabaþý¹, Sadettin Er², Þükrü Mehmet Ertürk^3
1Department of Radiology, University of Health Sciences, Somalia Turkey Recep Tayyip Erdoðan Training and Research Hospital, Mogadishu-Somali
²Department of General Surgery, University of Health Sciences, Somalia Turkey Recep Tayyip Erdoðan Training and Research Hospital, Mogadishu-Somali
³Department of Radiology, Ýstanbul University Ýstanbul Faculty of Medicine, Ýstanbul-Turkey

BACKGROUND: Acute appendicitis (AA) is a common cause of abdominal pain in developed countries. In patients with suspected AA, computed tomography (CT) is considered as the gold standard with the highest sensitivity and specificity, and it is also an im-portant modality, especially in patients with complicated AA. In this study, we aimed to evaluate age and laboratory findings, as well as specific CT findings in differentiating between perforated and non-perforated appendicitis.
METHODS: We retrospectively analyzed 252 patients diagnosed with AA and underwent appendectomy between November 2015 and December 2019 in Somalia Mogadishu Recep Tayyip Erdogan Education and Research Hospital. Patients under 18 years of age and those with no pre-operative CT scans were excluded from the study. The demographic, laboratory, CT findings, and pathological data of all patients were evaluated.
RESULTS: This study included 80 patients, 32 (40%) classified as perforated appendicitis (Group-1) and 48 (60%) as non-perforated appendicitis (Group-2). The C-reactive protein value was found to be statistically higher in Group-1 than in Group-2 (177.5±118.9 and 100.2±87.3 mg / L, respectively; p=0.001). The appendix lumen diameter (p=0.002), appendix wall defect (p<0.001), peritoneal thickening and enhancement (p<0.001), ascites (p=0.031), intra-abdominal abscess (p=0.003), jejunal thickening (p=0.019), ileal thick-ening (p=0.008), and ileus (p=0.035) values were significantly higher in Group-1. In the binominal logistic regression analysis performed with statistically significant data, an appendiceal wall defect (OR: 0.069, 95% CI=0.014–0.327, p=0.001) and peritoneal thickening and enhancement (OR: 0.131, 95% CI=0.024–0.714, p=0.019) were identified as independent variables for perforated appendicitis.
CONCLUSION: Among CT findings, appendix wall defects and peritoneal thickening and enhancement play an important role in detecting perforation.

Keywords: Acute appendicitis, computed tomography, perforation; peritoneal thickening and enhancement.

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