Top Tips for identifying the appendix

Portsmouth Hospitals University's PHD Fellow Ruth Reeve, Clinical Specialist GI Sonographer/Clinical Academic in the NHS Trust Ultrasound Department. These tips offer some great ways to identify the appendix. 

  1. Talk to your patient- Make time to take advantage of having the patient next to you and finding out more about their symptoms, where the pain is exactly located and find out what surgery (such as an appendectomy!) they may have had previously. All this information is important when scanning and writing your report.
  2. Choose your tools- Having a variety of transducers available is helpful when trying to locate the appendix. By using a low or mid-range frequency transducer you can get a good overview of where the caecum is and where you should focus further interrogation. A high frequency probe is ideal then for a more detailed assessment of the appendix.
  3. Under pressure- Applying graded compression during ultrasound assessment of the bowel helps to displace overlying structures and bowel gas which may obstruct views. Tell your patient you may be applying pressure so that they are prepared and ask them not to tense their abdomen where possible.
  4. Move around- Remember the appendix can be orientated in a variety of positions, if not identified with the patient laying supine, consider turning the patient into the left decubitus position to help find the retrocaecal appendix.
  5. Look at the surroundings- When identifying the appendix in suspected appendicitis, the mesentery is often a more helpful sonographic sign of inflammation than the size of the appendix itself. If seeing ill-defined, swollen and hyperechoic mesentery look closer to seek the appendix.