Summary of ultrasound diagnosis skills and frequently asked questions of appendicitis

Ultrasound diagnosis of appendicitis has always been a hot topic

Ultrasound diagnosis of appendicitis has always been a hot topic

What is the appendix? Where? What is the appendix? Where? What is the appendix? Where?

The appendix, also known as the vermis process, is a slender and curved blind tube located at the lower right of the abdomen, between the cecum and the ileum.

The appendix, also known as the vermis process, is a slender and curved blind tube located at the lower right of the abdomen, between the cecum and the ileum.

What we need to grasp is that at the bottom right, one end is a blind end, which is locked, and the position can be free and not fixed

Ultrasound appearance of normal appendix: Picture A shows the long axis, the lumen can be collapsed, and it can contain gas, bezoar, and a small amount of fluid

Five characteristics of a normal appendix: small tubular structure, blind end, compressibility, no Doppler signal, and no surrounding inflammatory fat

Five characteristics of a normal appendix: small tubular structure, blind end, compressibility, no Doppler signal, and no surrounding inflammatory fat

(Increase of surrounding medium and strong echogenic tissue, surrounding acute suppurative appendicitis) The

(Increase of surrounding medium and strong echogenic tissue, surrounding acute suppurative appendicitis) The

1.

Remember this sentence: to find the appendix, first find the ileocecal; to find the ileocecal, first find the ascending colon

1.

1.

2.

2.

3.
Within two centimeters below the posterior part of the ileocecal area, it should be the junction of the appendix
.
Therefore, after finding the ileocecal area, the probe should not be moved, but rotated on the spot, and the exit and proximal end of the appendix should be found
.
The appendix wall echo was strong-weak-strong
.
The appendix cavity is generally a line-like strong echo
.
3.
Within two centimeters below the posterior part of the ileocecal area, it should be the junction of the appendix
.
3.

be careful:

Note: Note:

1.
The appendix is ​​usually located in the right lower quadrant, but it can also be ectopic
.
Look carefully for the ascending colon and ileocecal
.

1.
The appendix is ​​usually located in the right lower quadrant, but it can also be ectopic
.
Look carefully for the ascending colon and ileocecal
.
The appendix is ​​usually located in the right lower quadrant, but it can also be ectopic
.

2.
Children , especially young children, because their bodies are relatively small, the appendix is ​​located in a relatively small section compared to adults, and it will be brought to organs such as kidneys or livers on one cut surface.
Don't think it is ectopic
.
(depending on the actual situation)

2.
Children , especially young children, because their bodies are relatively small, the appendix is ​​located in a relatively small section compared to adults, and it will be brought to organs such as kidneys or livers on one cut surface.
Don't think it is ectopic
.
(It should be considered in light of the actual situation) One section of a child will be brought to organs such as kidney or liver, so don’t think it is ectopic

3.
The probe should be selected with high frequency , and sometimes fat patients need to be viewed in turn with the low frequency probe
.

3.
The probe should be selected with high frequency , and sometimes fat patients need to be viewed in turn with the low frequency probe
.
The selection of high frequency needs to be combined with the low frequency probe to look at it in turn.

4.
When you can't find it, ask the patient where the pain is the most , and then look carefully there
.

4.
When you can't find it, ask the patient where the pain is the most , and then look carefully there
.
Ask the patient where the pain is the most

5.
The appendix is ​​mostly around the iliac vessels , so the iliac vessels are also an important sign to look for
.

5.
The appendix is ​​mostly around the iliac vessels , so the iliac vessels are also an important sign to look for
.
Vascular iliac vessels are also an important landmark to look for

6.
When you can't see clearly, you should gradually pressurize it to drive away intestinal qi
.

6.
When you can't see clearly, you should gradually pressurize it to drive away intestinal qi
.
Gradual pressure method to drive away intestinal gas

7.
With the improvement of the resolution of color ultrasound equipment, the normal appendix can be displayed
.
As long as you have careful, serious, patient and a good ultrasound equipment, the display rate of the normal appendix is ​​not less than 70%
.

7.
With the improvement of the resolution of color ultrasound equipment, the normal appendix can be displayed
.
As long as you have careful, serious, patient and a good ultrasound equipment, the display rate of the normal appendix is ​​not less than 70%
.

The diagnosis of appendicitis

2.
Diagnosis of appendicitis 2.
Diagnosis of appendicitis

1.
Simple appendicitis: It is a mildly swollen tube-like structure, usually between 6 and 10 mm in diameter, the appendix wall is thickened, the wall layer is still clear, and the appendix cavity is anechoic
.
May have bezoar strong echo group
.

1.
Simple appendicitis: It is a mildly swollen tube-like structure, usually between 6 and 10 mm in diameter, the appendix wall is thickened, the wall layer is still clear, and the appendix cavity is anechoic
.
May have bezoar strong echo group
.
1.
Simple appendicitis: 1.
Simple appendicitis:

2.
Suppurative appendicitis: The tension of the appendix​​increased, and the appendix is ​​obviously dilated (the echo of the fat around the arrow is enhanced, and the echo of the submucosa is not clear, indicating transmural inflammation), showing a cystic bag-like change
.
The diameter of the appendix is ​​often greater than 10 mm, and the wall of the appendix is ​​thickened, rough and fuzzy
.
See purulent light spot echoes in the cavity
.
(Sometimes appendicitis cannot be classified, it is like this type and it is like that type)

2.
Suppurative appendicitis: The tension of the appendix​​increased, and the appendix is ​​obviously dilated (the echo of the fat around the arrow is enhanced, and the echo of the submucosa is not clear, indicating transmural inflammation), showing a cystic bag-like change
.
The diameter of the appendix is ​​often greater than 10 mm, and the wall of the appendix is ​​thickened, rough and fuzzy
.
See purulent light spot echoes in the cavity
.
(Sometimes appendicitis cannot be classified, it is both like this type and that type) 2.
Suppurative appendicitis: 2.
Suppurative appendicitis:tension

3.
Gangrenous appendicitis: The wall of the appendix is ​​obviously thickened, discontinuous, and the outline is unclear, irregular hypoechoic areas can be seen, and the internal echoes are disordered
.
When combined with perforation, it is manifested as an irregular hypoechoic or anechoic mass in the right lower quadrant, often with punctate and gas-like strong echoes
.
Adhesion around the mass is obvious
.
(Signs of post-perforation peritonitis can be detected)

3.
Gangrenous appendicitis: The wall of the appendix is ​​obviously thickened, discontinuous, and the outline is unclear, irregular hypoechoic areas can be seen, and the internal echoes are disordered
.
When combined with perforation, it is manifested as an irregular hypoechoic or anechoic mass in the right lower quadrant, often with punctate and gas-like strong echoes
.
Adhesion around the mass is obvious
.
(Signs of peritonitis after perforation can be detected) 3.
Gangrenous appendicitis: 3.
Gangrenous appendicitis:

A, Transverse section: the ruler is the appendix, the submucosal disappears completely, the white arrow, the echo of the surrounding fat is enhanced, and the appendix is ​​wrapped, similar to the performance of the thyroid and trachea
.
B, Sagittal section long arrow, echoes of surrounding fat are enhanced, short arrow, echoes of submucosa at the distal end of appendix disappear completely

A, Transverse section: the ruler is the appendix, the submucosal disappears completely, the white arrow, the echo of the surrounding fat is enhanced, and the appendix is ​​wrapped, similar to the performance of the thyroid and trachea
.
B, Sagittal section long arrow, echoes of surrounding fat are enhanced, short arrow, echoes of submucosa at the distal end of appendix disappear completely

4.
Chronic appendicitis: The appendix has little tension, no swelling, poor continuity of the appendix wall, irregular shape, adhesion to surrounding organs, and poor peristalsis
.

4.
Chronic appendicitis: The appendix has little tension, no swelling, poor continuity of the appendix wall, irregular shape, adhesion to surrounding organs, and poor peristalsis
.
4.
Chronic appendicitis: 4.
Chronic appendicitis:

be careful:

Note: Note:

1.
Appendices with diameters less than 6mm should be treated in specific cases! Look at its peristalsis, look at its walls, look at its surroundings, combine clinical signs, combine laboratory tests, and so on
.

1.
Appendices with diameters less than 6mm should be treated in specific cases! Look at its peristalsis, look at its walls, look at its surroundings, combine clinical signs, combine laboratory tests, and so on
.
Appendices with a diameter of less than 6mm should be treated on a case-by-case basis!

2.
Appendices with diameters between 6 and 8 mm should be treated with care and comprehensively judged
.
Sometimes the appendix of a normal person is scanned, and it is often found that it exceeds 6mm
.

2.
Appendices with diameters between 6 and 8 mm should be treated with care and comprehensively judged
.
Sometimes the appendix of a normal person is scanned, and it is often found that it exceeds 6mm
.
Appendices with diameters between 6 and 8 mm should be treated with care and comprehensively judged
.

3.
The appendix must be scanned throughout the entire process.
Many proximal appendicitis is normal, but inflammation and swelling occur only at the distal end
.

3.
The appendix must be scanned throughout the entire process.
Many proximal appendicitis is normal, but inflammation and swelling occur only at the distal end
.
In many cases of appendicitis the proximal end is normal, only the distal end is inflamed, swollen

4.
Inflammatory infiltration around the appendix, resulting in thickening of surrounding fat and omentum, and enhanced echo
.
When you see patchy strong echoes, then there must be inflammation in this area
.

4.
Inflammatory infiltration around the appendix, resulting in thickening of surrounding fat and omentum, and enhanced echo
.
When you see patchy strong echoes, then there must be inflammation in this area
.
When you see patchy strong echoes, then there must be inflammation in this area
.

5.
The surrounding bowel sometimes dilates and accumulates fluid
.
Generally, if you see fluid in the ascending colon, it means a bit of intestinal paralysis
.

5.
The surrounding bowel sometimes dilates and accumulates fluid
.
Generally, if you see fluid in the ascending colon, it means a bit of intestinal paralysis
.
Generally, if you see fluid in the ascending colon, it means a bit of intestinal paralysis
.

6.
When scanning the appendix, the right kidney should be scanned at the same time to exclude kidney stones
.
Women should scan the attachments, especially when the right iliac fossa triangular effusion, must look at the attachments to rule out ectopic pregnancy, cyst rupture and other diseases
.

6.
When scanning the appendix, the right kidney should be scanned at the same time to exclude kidney stones
.
Women should scan the attachments, especially when the right iliac fossa triangular effusion, must look at the attachments to rule out ectopic pregnancy, cyst rupture and other diseases
.
The right kidney should be scanned at the same time to rule out kidney stones
.
Women who want to scan the attachments, especially when the right iliac fossa triangle effusion, must look at the attachments

7.
When the appendix is ​​swollen, it does not mean that there is a problem with the appendix.
It may be caused by inflammation of the surrounding organs
.
Pay attention to identification
.

7.
When the appendix is ​​swollen, it does not mean that there is a problem with the appendix.
It may be caused by inflammation of the surrounding organs
.
Pay attention to identification
.
It may be caused by inflammation of surrounding organs

8.
The older you are, the higher the possibility of chronic inflammation of the appendix (similar to gastritis and appendicitis)
.
If you look at the appendix of the elderly, you will have such an experience
.

8.
The older you are, the higher the possibility of chronic inflammation of the appendix (similar to gastritis and appendicitis)
.
If you look at the appendix of the elderly, you will have such an experience
.
The older you are, the more likely you are to develop chronic inflammation of the appendix

9.
Describe the course of the appendix.
The retroperitoneal appendix and the retrocecal appendix should be described in detail , which is helpful for surgical operations
.

9.
Describe the course of the appendix.
The retroperitoneal appendix and the retrocecal appendix should be described in detail , which is helpful for surgical operations
.
The retroperitoneal appendix and the retrocecal appendix should be described in detail

10.
The description of abdominal lymph nodes is also necessary , especially in children, which is helpful for clinical pediatric diagnosis
.

10.
The description of abdominal lymph nodes is also necessary , especially in children, which is helpful for clinical pediatric diagnosis
.
A description of the abdominal lymph nodes is also necessary

11.
Suggestion: Patients should not drink water before checking the appendix .
I recently checked 10 cases of early pregnant women who drank a lot of water and found that 4 cases had water filling in the appendix cavity, resulting in the diameter of the appendix exceeding 6mm
.

11.
Suggestion: Patients should not drink water before checking the appendix .
I recently checked 10 cases of early pregnant women who drank a lot of water and found that 4 cases had water filling in the appendix cavity, resulting in the diameter of the appendix exceeding 6mm
.
The patient should not drink water before the appendix examination

Summary of Frequently Asked Questions from Patients

Patient FAQ Summary Patient FAQ Summary

1.
Should acute appendicitis be treated surgically or conservatively?

1.
Should acute appendicitis be treated surgically or conservatively? 1.
Should acute appendicitis be treated surgically or conservatively?

If it is considered to be acute simple appendicitis, the local right lower quadrant pain is not severe, and there is no systemic symptoms such as fever, or there are special circumstances such as business trips that are inconvenient for surgery, conservative treatment can be considered first, and antibiotics are given to continue observation.
Aggravated, suppurative appendicitis, peritonitis performance, should be decisively taken surgical treatment
.
In addition, it should be pointed out that after the acute appendicitis is relieved by conservative treatment, more than 2/3 of the patients will relapse in different periods in the future, or turn into chronic appendicitis
.
Therefore, regardless of the cost of treatment or the number and degree of suffering suffered by the patient, surgery is the best choice for patients with acute appendicitis
.

If it is considered to be acute simple appendicitis, the local right lower quadrant pain is not severe, and there is no systemic symptoms such as fever, or there are special circumstances such as business trips that are inconvenient for surgery, conservative treatment can be considered first, and antibiotics are given to continue observation.
Aggravated, suppurative appendicitis, peritonitis performance, should be decisively taken surgical treatment
.
In addition, it should be pointed out that after the acute appendicitis is relieved by conservative treatment, more than 2/3 of the patients will relapse in different periods in the future, or turn into chronic appendicitis
.
Therefore, regardless of the cost of treatment or the number and degree of suffering suffered by the patient, surgery is the best choice for patients with acute appendicitis
.
Antibiotics surgery is the best option for patients with acute appendicitis, both in terms of cost of treatment or the number and degree of suffering the patient suffers
.

2.
If surgery, what surgery should I choose? Laparoscopic appendectomy or direct surgery?

2.
If surgery, what surgery should I choose? Laparoscopic appendectomy or direct surgery? 2.
If surgery, what surgery should I choose? Laparoscopic appendectomy or direct surgery?

The advantage of laparoscopy is that the incision is small, with only three points .
In fact, it is as big as an operation, but it is small and concealed
.

The advantage of laparoscopy is that the incision is small, with only three points .
In fact, it is as big as an operation, but it is small and concealed
.
The wound is small, only three points

Second, the wound surface is small, and the postoperative recovery is fast
.
It takes a week or two to recover from surgery to walk normally, and laparoscopy can be discharged in 2-3 days;

Second, the wound surface is small, and the postoperative recovery is fast
.
It takes a week or two to recover from surgery to walk normally, and laparoscopy can be discharged in 2-3 days; the wound surface is small, and the postoperative recovery is fast

Third, there are fewer complications , such as fat liquefaction without incision, and low risk of infection
.

Third, there are fewer complications , such as fat liquefaction without incision, and low risk of infection
.
Fewer complications than infections

But there are also disadvantages, because the field of vision is not enough, the appendix in some positions may not be found, and a surgery will be needed at that time
.
This is the case with me, because the position is deep, I can't find it and I'm afraid it won't cut cleanly, so I pulled a knife again
.

But there are also disadvantages, because the field of vision is not enough, the appendix in some positions may not be found, and a surgery will be needed at that time
.
This is the case with me, because the position is deep, I can't find it and I'm afraid it won't cut cleanly, so I pulled a knife again
.
The field of vision is not enough, the appendix in some positions may not be found, and a surgery will be needed at that time.

There is also the fear that the cut will not be clean, and then the residual inflamed appendix will form stump inflammation
.
One of my classmates had a laparoscopy and then had stump inflammation.
His doctor didn't admit it, and he had obvious McBurby's point tenderness and rebound tenderness.
Later, he prescribed anti-inflammatory drugs to take it
.

There is also the fear that the cut will not be clean, and then the residual inflamed appendix will form stump inflammation
.
One of my classmates had a laparoscopy and then had stump inflammation.
His doctor didn't admit it, and he had obvious McBurby's point tenderness and rebound tenderness.
Later, he prescribed anti-inflammatory drugs to take it
.
The cut is not clean, and then the residual inflamed appendix forms stumpitis

3.
What are the complications of acute appendicitis surgery?

3.
What are the complications of acute appendicitis surgery? 3.
What are the complications of acute appendicitis surgery?

1.
Complications of the incision

1.
Complications of incisions 1.
Complications of incisions

Including incision infection, chronic sinus tract and incisional hernia , mostly due to contamination of the incision during surgery
.
Gangrene or perforated appendicitis is especially prone to occur
.
Incision infection usually occurs 3 to 5 days after the operation, but it also occurs after two weeks
.
The main manifestations are that the patient's body temperature continues to rise or falls 3 to 5 days after the operation, and then rises again, the wound feels pain, the skin around the incision is red, swollen, tender, and even pus flows out of the incision
.
At this time, the sutures should be removed immediately, the wound should be fully drained, the necrotic tissue should be removed, and the dressing should be changed to promote wound healing
.
A small number of patients may develop chronic sinus tract and incisional hernia in the future, and reoperation can be performed as an option
.

Including incision infection, chronic sinus tract and incisional hernia , mostly due to contamination of the incision during surgery
.
Gangrene or perforated appendicitis is especially prone to occur
.
Incision infection usually occurs 3 to 5 days after the operation, but it also occurs after two weeks
.
The main manifestations are that the patient's body temperature continues to rise or falls 3 to 5 days after the operation, and then rises again, the wound feels pain, the skin around the incision is red, swollen, tender, and even pus flows out of the incision
.
At this time, the sutures should be removed immediately, the wound should be fully drained, the necrotic tissue should be removed, and the dressing should be changed to promote wound healing
.
A small number of patients may develop chronic sinus tract and incisional hernia in the future, and reoperation can be performed as an option
.
Incision infection, chronic sinus and incisional hernia gangrene or perforated appendicitis are especially prone to occur
.
The main manifestations are that the patient's body temperature continues to rise or falls 3 to 5 days after the operation, and then rises again, the wound feels pain, the skin around the incision is red, swollen, tender, and even pus flows out of the incision
.

2.
Intraperitoneal hemorrhage

2.
Intraperitoneal hemorrhage 2.
Intraperitoneal hemorrhage

Mostly due to insufficient hemostasis of the mesangial appendix or loosening of the vascular ligature during surgery
.
The main symptoms are the patient's pale complexion, rapid pulse, cold sweat, abdominal pain, abdominal distension, and even a drop in blood pressure and other shock symptoms .
The patient should be immediately placed in a supine position, sedated, oxygen inhaled, intravenous infusion, and cross-matched to prepare for surgery to stop bleeding
.

Mostly due to insufficient hemostasis of the mesangial appendix or loosening of the vascular ligature during surgery
.
The main symptoms are the patient's pale complexion, rapid pulse, cold sweat, abdominal pain, abdominal distension, and even a drop in blood pressure and other shock symptoms .
The patient should be immediately placed in a supine position, sedated, oxygen inhaled, intravenous infusion, and cross-matched to prepare for surgery to stop bleeding
.
Mostly due to insufficient hemostasis of the mesangial appendix or loosening of the vascular ligature during surgery
.
Pale complexion, rapid pulse, cold sweats, abdominal pain, bloating, and even shock symptoms such as a drop in blood pressure

3.
Abdominal residual abscess

3.
Abdominal residual abscess 3.
Abdominal residual abscess

After appendectomy for gangrenous or perforated appendicitis, the absorption of pus in the abdominal cavity is incomplete, and residual abscesses can form in different parts of the abdominal cavity
.
Pelvic abscesses are the most common , most of which occur 5 to 10 days after the operation, and are mainly characterized by persistent high fever, abdominal pain, abdominal distension, and tenesmus.
Digital anorectal examination shows relaxation of the sphincter and bulge of the anterior wall of the rectum
.
Attention should be paid to semi-recumbent drainage to allow secretions or pus to flow into the pelvic cavity and reduce poisoning
.
At the same time strengthen antibiotic treatment
.
If no improvement is seen, drainage surgery is recommended
.

After appendectomy for gangrenous or perforated appendicitis, the absorption of pus in the abdominal cavity is incomplete, and residual abscesses can form in different parts of the abdominal cavity
.
Pelvic abscesses are the most common , most of which occur 5 to 10 days after the operation, and are mainly characterized by persistent high fever, abdominal pain, abdominal distension, and tenesmus.
Digital anorectal examination shows relaxation of the sphincter and bulge of the anterior wall of the rectum
.
Attention should be paid to semi-recumbent drainage to allow secretions or pus to flow into the pelvic cavity and reduce poisoning
.
At the same time strengthen antibiotic treatment
.
If no improvement is seen, drainage surgery is recommended
.
Pelvic abscess is the most common persistent high fever, abdominal pain, abdominal distension, accompanied by tenesmus, digital anorectal examination shows sphincter relaxation, rectal anterior wall bulge

4.
Appendic stumpitis

4.
appendix stumpitis 4.
appendix stumpitis

When appendectomy was performed, the appendix was not completely removed at the root of the appendix, and a small part of the root of the appendix remained, which caused the basic cause of appendicitis, and the obstruction of the appendix cavity could not be eradicated
.
Appendicitis may recur after surgery
.
If appendix stumpitis occurs, conservative treatment can be performed first, and if it recurs, surgical resection of the remaining appendix root is required
.

When appendectomy was performed, the appendix was not completely removed at the root of the appendix, and a small part of the root of the appendix remained, which caused the basic cause of appendicitis, and the obstruction of the appendix cavity could not be eradicated
.
Appendicitis may recur after surgery
.
If appendix stumpitis occurs, conservative treatment can be performed first, and if it recurs, surgical resection of the remaining appendix root is required
.
Appendicitis may recur after surgery
.

5.
Fecal fistula

5.
Fecal fistula 5.
Fecal fistula

Fecal fistulas are usually colonic fistulas, usually confined to the right lower abdomen around the cecum, rarely forming diffuse peritonitis
.
The patient's body temperature is generally not very high, and nutritional deficiencies are not serious
.
Most of them heal on their own after antibiotic treatment
.
If the course of the disease has not healed for more than 3 months, surgery should be performed again
.

Fecal fistulas are usually colonic fistulas, usually confined to the right lower abdomen around the cecum, rarely forming diffuse peritonitis
.
The patient's body temperature is generally not very high, and nutritional deficiencies are not serious
.
Most of them heal on their own after antibiotic treatment
.
If the course of the disease has not healed for more than 3 months, surgery should be performed again
.
The patient's body temperature is generally not very high, and nutritional deficiencies are not serious
.
Most of them heal on their own after antibiotic treatment
.

6.
Adhesive intestinal obstruction

6.
Adhesive ileus 6.
Adhesive ileus

It is related to the severity of intra-abdominal inflammation, surgical injury, foreign body stimulation, etc.
Generally, comprehensive conservative treatment is firstly performed, and surgery should be performed when it is ineffective
.

It is related to the severity of intra-abdominal inflammation, surgical injury, foreign body stimulation, etc.
Generally, comprehensive conservative treatment is firstly performed, and surgery should be performed when it is ineffective
.
Generally, comprehensive conservative treatment is firstly performed.
If it is invalid, surgery should be performed

.