الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute appendicitis is the most common abdominal surgical emergency in pediatric age group. The diagnosis of appendicitis rests on clinical findings and investigations, comprising laboratory analysis and imaging studies.
Ultrasound is the first imaging modality in diagnosis of appendicitis due to its multiple advantages over the other imaging modalities.
Equivocal or non-diagnostic ultrasound examinations, where the appendix is not visualized or where it is seen with borderline measurement are highly reported. Hence, multiple objective secondary sonographic signs are sought to aid in the diagnosis of acute appendicitis and to increase the diagnostic performance of ultrasound.
In the current study, ultrasound examination was performed in all pediatric patients presented to the emergency room with suspected appendicitis. Multiple sonographic findings were reported, including appendix diameter if visualized, right iliac fossa fluid, regional reactionary lymph nodes, right iliac fossa echogenic fat planes, nearby reactive ileus, abscess formation, as well as main portal vein diameter and velocity.
We measured the portal vein diameter and velocity to assess their effectiveness as objective secondary signs in ultrasound diagnosis of appendicitis. We found that the portal vein diameter was an insignificant parameter in diagnosis of appendicitis, yet portal vein velocity was a highly significant parameter.
On the other hand, the use of portal vein velocity as a supplementary tool to ultrasound improved its diagnostic performance and increased its sensitivity, thus, decreasing the incidence of delayed appendectomies that have an increased risk of complications as well as decreasing the incidence of unnecessary appendectomies.
RECOMMENDATIONS:
Further dedicated studies that measure portal vein diameter and velocity in different body habitus as well as in correlation with patients’ age and sex are recommend to assess variability in measurements to provide a more comprehensive guideline for the use of those objective tools in different patients.
Standardized techniques must be done in sonographic assessment of the portal vein diameter and velocity to eliminate the performance and technically discrepant results.
Moreover, further evaluation by studies with different study designs on larger patient cohorts, with follow up of the patients and correlation with healthy control groups, are required to validate the results and to assure that our data are representative of the population.