Patients who had right lower quadrant abdominal pain remain a diagnostic challenge. Ultrasonography or barium enema was performedsometimes in clinically obscure conditions. We expected that the the sonographic examination after the filling of the
cecum
with saline could provide both the benefits of ultrasonography and barium enema for the diagnosis of appendicitis. Twenty four patients who had ambiguous appendicitis on clinical grounds were examined. There were 9males and 15 females(range of 8
to
56
years old). After the colon was cleaned with polyethylene glycol or glycerin enema, one to two liter of normal saline was infused into the cecum by a rectal tube. After then, the sonographic examination was done as usual maneuver. We set the
guidelines
for the interpretation as following: 'appendicitis positive' -visible inflamed appendix, nonvisualization or partial visualization of water-filled appendix. Surgical exploration was done in 13 positive cases, but in 4 cases that the symptom was
relived,
operation was not performed in spite of sonographically positive findings. According to these guidelines, ture positive(sonographically positive and surgically proven) was 7 cases, true negative (sonographically negative and clinically relieved)
8
cases, and false positive(sonorphically positive and surgically free or clinically relieved) 9 cases, respectively. there were no cases of false negative(sonographically negative and clinically unrelieved). We herein included 3 patients who had
suffered
from chronic recurent pain for 6 or more months duration. One was true positive who had fibrous obliteration of the lumen in the appendectomized specimen, another was true negative with complete visualization of water-filled appendix in
sonography,
and
the third was false positive on exploration. Water-filled appendiceal sonography had a sensitivity rate of 100 percent, a positive predictive value of 44 percent, and negative predictive value of 100 percent for the detection of appendicitis.
There
was
no difference in accuracy between child(below 15 years old) and adult. We conclude as following.①Considering that there were no cases of 'false negative, operative management should be abandoned in sonographically negative cases. ②The
theroretical
possibility that this prodcedure would be more helpful in children who had wider base of the apendix than in adults was not true. ③This examination could also be one of the modalities for the diagnosis of chronic appendicitis.
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