title: Distinct sonographic features of acute appendicitis in sickle cell disease.
abstract: OBJECTIVE
  The purpose of this study was to report sonographic findings of appendicitis in patients with positive screening tests for sickle cell compared to normal control patients.
  
  
  METHODS
  A retrospective study of the medical records of 396 patients who underwent appendectomy during a 3-year period from March 2005-2008.
  
  
  METHODS
  The study included 216 males and 180 females, whose ages ranged from 7 to 55 years. Four patients (0.9%) had sickle cell disease (SCD), 101 had sickle cell trait (SCT) (25%) and 291 (74%) patients were without sickle cell anemia (control group).
  
  
  RESULTS
  Positive sonographic findings of appendicitis were identified in 95 (90%) SCT patients and in 253 (87%) control patients. The mean maximal mural thickness was higher in sickle cell patients (4.5 [1.4] mm) in comparison with the control group (3.0 [2.2] mm) (P < .0001). Appendicolith was significantly detected in 53% of the control group and in 8.5% of the sickle cell group (P < .0001). Color Doppler showed hypervascularity in 72% of patients with appendicitis in the control group with a significant difference compared to only 12 cases (11%) of SC patients (P < .05). Ultrasonography findings suggesting perforation were found in 35 sickle cell patients and in 75% (3 of the 4 patients) with SCD. Findings suggesting perforation were found only in 49 patients (17%) of the control group. Perforated appendix was significantly higher in sickle cell patients in preoperative US and intraoperatively (P < .05)
  
  
  CONCLUSIONS
  Positive sonographic findings of appendicitis in sickle cell patients are different from the general population. These findings include mural thickening with a low incidence of appendicolith and wall hypervascularity. Also sonographic features of perforation in sickle cell patients are more common suggesting a need for more urgent operative intervention.
authors: Surgery Department, Mouwasat Hospital, Qatif, Saudi Arabia. sherifmonib@gmail.com
authors: Sherif
authors: S
authors: Monib
authors: Ragab H
authors: RH
authors: Donkol
authors: Ahmad
authors: A
authors: Hassan
authors: Amjid A
authors: AA
authors: Riaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods