Abstract
Amaç: İştahsızlık (anoreksi), akut apandisitli hastalarda yaygın görülen bir semptomdur. Bu hastalarda iştahsızlık nedeniyle mide içeriğinin boş, safra kesesinin ise kontrakte olduğu öne sürülebilir. Bu çalışmada akut apandisitli hastalarda mide doluluğu ve safra kesesi durumu incelenmiştir. Bu parametrelerin, anoreksinin görüntüleme bulgularıyla dolaylı olarak desteklenip desteklenemeyeceği ve acil cerrahi planlamasında aspirasyon riski açısından ne derece anlamlı olduğu araştırılmıştır.
Gereç ve Yöntemler: Akut apandisit tanısı alan hastalar ile kontrol grubuna ait BT görüntüleri, mide doluluğu ve safra kesesi görünümü açısından değerlendirilmiştir.
Bulgular: Toplamda 266 hasta çalışmaya dahil edilmiştir. Hastaların 139’u (%52,3) akut apandisit tanısı almışken, 127’si (%47,7) kontrol grubu olarak sınıflandırılmıştır. Mide içeriği boş olan hastaların oranı, akut apandisitli hastalarda kontrol grubuna kıyasla istatistiksel olarak anlamlı derecede daha yüksekti (p<0,001). Akut apandisit vakalarının %23’ünde (n=32) mide doluluk derecesi 3 (aspirasyon için yüksek risk taşıyan katı mide içeriği) olarak değerlendirilmiştir.
Sonuç: Mide doluluğu ve safra kesesi kontraksiyonu, akut apandisitten şüphelenilen vakalarda dolaylı kanıt sağlayabilecek, BT ile kolaylıkla değerlendirilebilen bulgulardır. Anoreksi, akut apandisitin önemli bir semptomu olmasına rağmen, hastaların yarısından fazlası düzensiz de olsa oral alıma devam etmekte ve bu durum olası bir acil operasyonda hastaların beşte birini aspirasyon riski altında bırakmaktadır. Bu nedenle, preoperatif açlık protokollerinde yalnızca anoreksinin varlığına güvenmek uygun değildir.
Ethical Statement
Düzce Üniversitesi, Girişimsel olmayan sağlık araştırmaları etik kurulu, karar no:2021/123, tarih: 05.03.2021
References
- Pittman-Waller VA, Myers JG, Stewart RM, Dent DL, Page CP, Gray GA, et al. Appendicitis: why so complicated? Analysis of 5755 consecutive appendectomies. Am Surg. 2000; 66(6): 548-54.
- Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, et al. The global incidence of appendicitis: a systematic review of population-based studies. Ann Surg. 2017; 266(2): 237-41.
- Buckley RG, Distefan J, Gubler KD, Slymen D. The risk of appendiceal rupture based on hospital admission source. Acad Emerg Med. 1999; 6(6): 596-601.
- Lane MJ, Mindelzun RE. Appendicitis and its mimickers. Semin Ultrasound, CT MRI. 1999; 20(2): 77-85.
- Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020; 15(1): 27.
- Kouame N, N’Goan-Domoua AM, N’dri KJ, Konan AN, Yao-Bathaix MF, N'gbesso RD, et al. The diagnostic value of indirect ultrasound signs during acute adult appendicitis. Diagn Interv Imaging. 2012; 93(3): 24-8.
- Malkomes P, Edmaier F, Liese J, Reinisch-Liese A, El Youzouri H, Schreckenbach T, et al. DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis. Langenbeck’s Arch Surg. 2021; 406(1): 141-52.
- Kimura Y, Yamauchi M, Inoue H, Kimura S, Yamakage M, Aimono M, et al. Risk factors for gastric distension in patients with acute appendicitis: a retrospective cohort study. J Anesth. 2012; 26(4): 574-8.
- Hasanin A, Abdelmottaleb A, Elhadi H, Arafa AS, Mostafa M. Evaluation of gastric residual volume using ultrasound in fasting patients with uncomplicated appendicitis scheduled for appendectomy. Anaesth Crit Care Pain Med. 2021; 40(3): 100869.
- Andersson REB. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004; 91(1): 28-37.
- Kalliakmanis V, Pikoulis E, Karavokyros IG, Felekouras E, Morfaki P, Haralambopoulou G, et al. Acute appendicitis: the reliability of diagnosis by clinical assessment alone. Scand J Surg. 2005; 94(3): 201-6.
- Smith MP, Katz DS, Lalani T, Carucci LR, Cash BD, Kim DH, et al. ACR appropriateness criteria® right lower quadrant pain—suspected appendicitis. Ultrasound Q. 2015; 31(2): 373-87.
- Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, et al. How to diagnose acute appendicitis: ultrasound first. Insights Imaging. 2016; 7(2): 255-63.
- Evain J-N, Allain T, Dilworth K, Rabattu PY, Mortamet G, Desgranges FP, et al. Ultrasound assessment of gastric contents in children before general anaesthesia for acute appendicitis. Anaesthesia. 2022; 77(6): 668-73.
- Perlas A, Arzola C, Van de Putte P. Point-of-care gastric ultrasound and aspiration risk assessment: a narrative review. Can J Anaesth. 2018; 65(4): 437-48.
- Perlas A, Van de Putte P, Van Houwe P, Chan VWS. I-AIM framework for point-of-care gastric ultrasound. Br J Anaesth. 2016; 116(1): 7-11.
- Gültekin Y, Kılıç Ö, Özçelik Z, Toprak ŞS, Bayram R, Arun O. Can gastric volume be accurately estimated by ultrasound? Turkish J Anaesthesiol Reanim. 2022; 50(3): 194-200.
Abstract
Aim: Loss of appetite (anorexia) is a prevalent symptom in patients with acute appendicitis. In these cases, it can be hypothesized that the stomach is empty, and the gallbladder is contracted due to loss of appetite. In this study, we aimed to investigate gastric fullness and gallbladder status in patients with acute appendicitis. We investigated whether these parameters can be indirectly supported by imaging findings of anorexia and to what extent they are significant in terms of aspiration risk in emergency surgery planning.
Material and Methods: CT images of patients with acute appendicitis and the control group were evaluated for gastric fullness and gallbladder appearance.
Results: A total of 266 patients were included in the study. A hundred and thirty-nine patients (52.3%) were diagnosed with acute appendicitis, while 127 patients (47.7%) were classified as the control group. The proportion of patients with an empty stomach was statistically significantly higher in patients with acute appendicitis compared to the control group (p<0.001). Gastric filling grade 3 (high-risk solid gastric content for aspiration) was in 23% (n=32) of the cases with acute appendicitis.
Conclusion: Gastric fullness and gallbladder contraction are straightforward findings on CT that can provide indirect evidence in suspected acute appendicitis cases. Although anorexia is a key symptom, over half of patients continue oral intake irregularly, leaving up to one-fifth at high risk for aspiration during emergency surgery. Therefore, preoperative starvation protocols should not rely solely on the presence of anorexia.
Ethical Statement
Düzce University, Non-interventional health research ethics committee, decision no: 2021/123, date: 05.03.2021
References
- Pittman-Waller VA, Myers JG, Stewart RM, Dent DL, Page CP, Gray GA, et al. Appendicitis: why so complicated? Analysis of 5755 consecutive appendectomies. Am Surg. 2000; 66(6): 548-54.
- Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, et al. The global incidence of appendicitis: a systematic review of population-based studies. Ann Surg. 2017; 266(2): 237-41.
- Buckley RG, Distefan J, Gubler KD, Slymen D. The risk of appendiceal rupture based on hospital admission source. Acad Emerg Med. 1999; 6(6): 596-601.
- Lane MJ, Mindelzun RE. Appendicitis and its mimickers. Semin Ultrasound, CT MRI. 1999; 20(2): 77-85.
- Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020; 15(1): 27.
- Kouame N, N’Goan-Domoua AM, N’dri KJ, Konan AN, Yao-Bathaix MF, N'gbesso RD, et al. The diagnostic value of indirect ultrasound signs during acute adult appendicitis. Diagn Interv Imaging. 2012; 93(3): 24-8.
- Malkomes P, Edmaier F, Liese J, Reinisch-Liese A, El Youzouri H, Schreckenbach T, et al. DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis. Langenbeck’s Arch Surg. 2021; 406(1): 141-52.
- Kimura Y, Yamauchi M, Inoue H, Kimura S, Yamakage M, Aimono M, et al. Risk factors for gastric distension in patients with acute appendicitis: a retrospective cohort study. J Anesth. 2012; 26(4): 574-8.
- Hasanin A, Abdelmottaleb A, Elhadi H, Arafa AS, Mostafa M. Evaluation of gastric residual volume using ultrasound in fasting patients with uncomplicated appendicitis scheduled for appendectomy. Anaesth Crit Care Pain Med. 2021; 40(3): 100869.
- Andersson REB. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004; 91(1): 28-37.
- Kalliakmanis V, Pikoulis E, Karavokyros IG, Felekouras E, Morfaki P, Haralambopoulou G, et al. Acute appendicitis: the reliability of diagnosis by clinical assessment alone. Scand J Surg. 2005; 94(3): 201-6.
- Smith MP, Katz DS, Lalani T, Carucci LR, Cash BD, Kim DH, et al. ACR appropriateness criteria® right lower quadrant pain—suspected appendicitis. Ultrasound Q. 2015; 31(2): 373-87.
- Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, et al. How to diagnose acute appendicitis: ultrasound first. Insights Imaging. 2016; 7(2): 255-63.
- Evain J-N, Allain T, Dilworth K, Rabattu PY, Mortamet G, Desgranges FP, et al. Ultrasound assessment of gastric contents in children before general anaesthesia for acute appendicitis. Anaesthesia. 2022; 77(6): 668-73.
- Perlas A, Arzola C, Van de Putte P. Point-of-care gastric ultrasound and aspiration risk assessment: a narrative review. Can J Anaesth. 2018; 65(4): 437-48.
- Perlas A, Van de Putte P, Van Houwe P, Chan VWS. I-AIM framework for point-of-care gastric ultrasound. Br J Anaesth. 2016; 116(1): 7-11.
- Gültekin Y, Kılıç Ö, Özçelik Z, Toprak ŞS, Bayram R, Arun O. Can gastric volume be accurately estimated by ultrasound? Turkish J Anaesthesiol Reanim. 2022; 50(3): 194-200.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences (Other) |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | May 22, 2025 |
| Submission Date | February 10, 2025 |
| Acceptance Date | April 22, 2025 |
| Published in Issue | Year 2025 Volume: 15 Issue: 2 |
