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Acute Appendicitis with the Presence of Peristalsis Seen in Ultrasound

ABSTRACT: A 27-year-old male patient presented in the emergency department (ED) with right acute abdominal pain, tenderness of the abdominal wall, and abdominal guarding. With suspicion of acute appendicitis, we performed bedside sonography. A blind-ending tubular structure, originating from the base of cecum with the presence of an intraluminal calcified “stone,” with the presence of clear peristalsis was seen. Whether this structure represented the appendix or the small bowel, it was not distinguishable sonographically. A consequent surgical consultation indicated a computer tomography scan, and the finding showed acute appendicitis with appendicolith. An inflamed appendix of 15 cm in length was seen laparoscopically and consequently an appendectomy was performed. The histology confirmed a putrid, ulcero-phlegmonous, and hemorrhagic appendicitis with appendicolith. Postoperatively, the patient made a good recovery without complications. The absence of peristalsis is a well-known criterion for diagnosing acute appendicitis. However, we have shown here, that this should be taken into account with caution, as in rare cases such as this appendicitis can be present with peristalsis.

SUBMITTER: Mohan V

PROVIDER: S-EPMC9272724 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Objectives: Endometrial peristalsis (EP) in non-pregnant uterine can be assessed by visual assessment of transvaginal ultrasound (TVUS). However, visual assessment is subjective, and the outcome depends on the sonographers and video analysts. This study aimed to create a newly developed automatic analysis algorithm for measuring the EP compared to visual assessment. Methods: A retrospective analysis was performed using the datasets from in vitro fertilization and embryo transfer (IVF-ET), who underwent the evaluation of EP by TVUS within 5 days prior to transplantation. 158 cine TVUS images were used to develop the automated analysis algorithm, and 37 cine TVUS images were evaluated by both visual and automated analysis algorithms. The algorithm was developed by applying the optical flow technology and enabled objective analysis of the number, direction, and intensity of EP. Results: The number of peristaltic waves counted by visual assessment was 4.2 ± 2.3 (mean ± standard deviation) and 4.1 ± 2.1 for doctors one and two, respectively. The number of waves counted with the algorithm was 3.6 ± 2.1 at first evaluation and 3.7 ± 2.0 at repeated evaluation. A significant difference was found between the algorithm count and visual assessment (p = 0.001, 0.002, 0.003, 0.008). The ICC values for algorithm versus manuals ranged from 0.84 to 0.96 and 0.87 to 0.96. The numbers of the cervix-to-fundus (CF), fundus-to-cervix (FC), and both cervix-to-fundal and fundus-to-cervix (CF + FC) directions of EP counted by the algorithm were 50, 52, and 32, respectively. The numbers counted by visual assessment were 43, 45, and 46, respectively. The number of EP was the same in 87% of the two algorithm counts. The number was lower between the algorithm and visual analysis (79% with complete agreement). The EP intensity assessed by the algorithm was 2.6 ± 1.1, and the peristalsis velocity was 0.147 (0.07) mm/s. Conclusion: The fully automated analysis algorithm can be used to quantify uterine peristalsis comparable to visual assessment.

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Acute Appendicitis with the Presence of Peristalsis Seen in Ultrasound

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