Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.117100
Revised: February 2, 2026
Accepted: February 10, 2026
Published online: March 27, 2026
Processing time: 77 Days and 3.6 Hours
Accurate preoperative differentiation between simple and suppurative appen
To investigate the clinical value of color Doppler ultrasound in preoperative typing diagnosis of acute appendicitis, using postoperative pathological results as the gold standard, to determine the optimal ultrasound diagnostic threshold for differentiating simple appendicitis from suppurative appendicitis, and to provide objective evidence for surgical approach selection, timing of surgery, and prevention of postoperative complications.
Clinical data of patients who underwent appendectomy and were pathologically confirmed with acute appendicitis between January 2021 and December 2024 were retrospectively analyzed. All patients underwent preoperative color Doppler ultrasound examination. Ultrasound parameters including maximum appendiceal diameter, appendiceal wall thickness, peri-appendiceal fluid, and blood flow signal grade were recorded. Surgical approach (open or laparoscopic), operative time, intraoperative findings, and postoperative pathological diagnosis were collected. Using postoperative pathological results as the gold standard, patients were divided into simple appendicitis group and suppurative appendicitis group. Independent sample t-test was used to compare normally distributed continuous data between groups, while Mann-Whitney U test was applied for non-normally distributed data. Categorical variables were compared using χ2 test or Fisher’s exact test as appropriate. Receiver operating characteristic (ROC) curves were plotted to calculate the area under the curve (AUC), sensitivity, and specificity for each parameter, and to determine the optimal diagnostic threshold. Multivariate logistic regression analysis was performed to identify independent predictive factors and establish a combined preoperative ultrasound diagnostic model.
A total of 328 patients with acute appendicitis who underwent appendectomy were included, comprising 186 cases of simple appendicitis and 142 cases of suppurative appendicitis. The suppurative appendicitis group showed significantly higher maximum appendiceal diameter (11.8 ± 2.3 mm vs 8.5 ± 1.6 mm), appendiceal wall thickness (3.8 ± 0.9 mm vs 2.4 ± 0.6 mm), and blood flow signal grade compared to the simple appendicitis group (P < 0.05). Operative time (68.5 ± 15.2 minutes vs 45.3 ± 12.8 minutes), postoperative hospital stays (5.8 ± 1.4 days vs 3.2 ± 0.9 days, and complication rate (18.3% vs 4.8%) were also significantly higher (P < 0.05). ROC curve analysis showed: The optimal diagnostic threshold for maximum appendiceal diameter was 9.8 mm (AUC = 0.876, sensitivity 85.2%, specificity 81.7%); for appendiceal wall thickness was 3.2 mm (AUC = 0.852, sensitivity 82.4%, specificity 79.6%); blood flow signal grade ≥ II showed AUC = 0.823, sensitivity 78.9%, specificity 76.3%. Multivariate logistic regression analysis identified maximum appendiceal diameter (OR = 3.42, 95%CI: 2.18-5.37), appendiceal wall thickness (OR = 2.89, 95%CI: 1.85-4.52), and blood flow signal grade (OR = 2.64, 95%CI: 1.72-4.05) as independent risk factors for predicting suppurative appendicitis (P < 0.05). The combined diagnostic model achieved AUC of 0.924 (sensitivity 91.5%, specificity 87.6%), with preoperative prediction accuracy of 89.3%. Among patients diagnosed with suppurative appendicitis by preoperative ultrasound, 73.2% underwent open surgery; while 86.5% of patients diagnosed with simple appendicitis successfully underwent laparoscopic surgery with faster recovery.
Color Doppler ultrasound can accurately differentiate acute simple appendicitis from suppurative appendicitis before appendectomy. The optimal diagnostic thresholds based on ultrasound parameters show high concordance with postoperative pathological results. Preoperative ultrasound typing diagnosis provides important reference for surgeons in selecting appropriate surgical approaches (open vs laparoscopic), timing of surgery, risk assessment, and prevention of postoperative complications, helping to optimize perioperative management, shorten hospital stay, and improve patient prognosis.
Core Tip: This study establishes quantitative ultrasound thresholds for differentiating simple and suppurative appendicitis and develops a combined predictive model with high diagnostic accuracy. By integrating appendiceal diameter, wall thickness, and blood-flow grade, the model significantly improves preoperative assessment and directly guides surgical approach selection, reducing conversion to open surgery and postoperative complications.