When sonographic study with a significant degree of confidence not only to determine the form of inflammatory transformation of the appendix, but also to obtain data on the characteristics of its location. This is of particular importance in atypical localizations appendix. It is the location of the appendix determines the clinical manifestations of appendicitis in children, creating additional diagnostic difficulty. Sonography in such situations in most cases allows to specify the diagnosis, determine the characteristics of surgical access during appendectomy. By atypical localization include obstructive, pelvic, and retroperitoneal location retrotsekalnoe appendix.
When podpechepochnom location echo graphic identification of the amended appendix enough available due to the fact that the edge of the liver acts in these cases as an acoustic window, creating additional conditions for the determination of the appendix. To identify obstructive located appendix is optimal skew scan along the edge of the liver in the upper right lateral canal and longitudinal scan along the ascending colon. When subhepatic location modified process in children have expressed diffuse changes in adjacent organs. This is manifested mild diffuse changes of the liver parenchyma by increasing vascular pattern, irregular thickening of the gallbladder wall, the appearance of the dispersed suspension in its lumen. Location in pelvic fragments inflamed appendix seen at transverse scanning directly to the right above the pubis.
In some cases, when the process is closely adjacent to the side wall of the bladder in children of both sexes defined isolated thickening the plot of its wall, adjacent to the appendix The girls had moderate diffuse reactive changes of the right ovary in the form of a larger middle-aged compared with the norm and fuzzy contours. Significantly increased in size due to pronounced reactive changes right appendage in some cases completely escapes the “zone of interest” that interferes with the amended definition of the appendix, does not permit a reliable echographic conclusion. In such situations, to clarify the nature of pathological changes in the pelvic cavity justified laparoscopy. Accumulation of free fluid in children of this group celebrated primarily in the pelvis behind the bladder or pozadimatochnom space (for girls).
When retrotsekalyyum location of the appendix, a definitive diagnosis of its changes in most cases difficult. This is associated with marked reactive changes of the dome of the cecum as a thickening of its walls and strengthen rigidity that prevents its compression. Also attached to the planar cecum adhesions process in most cases it is impossible to differentiate from the rear wall. However, some patients can see a fragment re – located trotsekalno diseased appendix. Best in these situations is a longitudinal scan in the direction from the cecum and along the ascending colon. In most cases, the presence of pain, detectable with sonographic study of inflammatory changes of the cecum (in the form of a reduction of its peristaltic activity, thickening of the walls, marked rigidity) and the inability to get a clear picture of the appendix should be carried out laparoscopically.