Dirk Schaper (Klinik für Kinderchirurgie-Krankenhaus St. Elisabeth und St. Barbara Halle)  

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7 Years  

Male  

GI-Large intestine  

physical  

7 year-old boy with slight abdominal discomfort for 10 days. No vomiting, no fever. No other symptoms.
Abdomen is soft, no localized pain upon pressure.
Spontaneous pain in the right lower quadrant.  

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<- view Ultrasound 1

Ultrasound 1: Initial sonographic examination: right lower quadrant (RLQ), tubular swollen, non-echogenic structure with echogenic, intermittent internal echoes. Non-compressable, no compression pain with transducer. In the longitudinal and transverse views, composition of the walls are well-differentiated.





<- view Ultrasound 2

Ultrasound 2: Initial sonographic examination: Bulls-eye in the RLQ with well-differentiated walls (base area)





<- view Ultrasound 3

Ultrasound 3: Initial sonographic examination: Longitudinal image of the tubular structure, which becomes narrower more medially. (base)





<- view Ultrasound 4

Ultrasound 4: Sonographic examination 3 days later: Tubular structure with normal wall structure.





<- view Ultrasound 5

Ultrasound 5: Sonographic examination 3 days later: Transverse view of a bulls-eye structure which is near the cecum with normal wall structure 5.7 mm (base)





<- view Ultrasound 6

Ultrasound 6: Follow-up examination after 7 days: Longitudinal view with a tubular, swollen structure with echogenic contents. Somewhat compressable, layers of the walls normal.





<- view Ultrasound 7

Ultrasound 7: Follow-up examination after 7 days: Longitudinal and transverse views of the same structure.


 

Total constellation (Consens)  

Typical appendicitis  

In the first sonographic examination there was a suspicion of appendicitis (images 1-3). The increased size of the internal space, which was larger than the limits of 6 mm and the fact that you could not compress the structure led us to this train of thought. The missing paraclinic and symptoms were factors that led us away from this diagnosis, and we did not operate on the patient and waited 3 days to perform our follow-up examination. Clinically, there was no further or new findings. In the ultrasound, there was an appendix that was less filled (image 4 & 5). In the follow up images (6 & 7), the appendix showed an increase if fullness, but the patient was symptomless. An operation was not yet performed. We have never seen a persistence of this before. In doppler studies, no increased in circulation was seen on any day. Since the appendix was barely compressable and since it did not empty during the examination, we assume that there was a temporary obstruction with spontaneous regression. The option of a laparoscopic appendectomy was agreed upon with the patient's parents if the symptoms persisted.  

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appendicitis, appendix, temporary obstruction, abdominal pain, appendix obstruction, appendectomy, child, childhood, pediatric radiology  

Dirk Schaper. Temporary Obstruction of the Appendix. PedRad [serial online] vol 5, no. 11.
URL: www.PedRad.info/?search=20051117133349