A Roentgenologic Study of 115 Cases of Appendectomy for So-called Chronic Appendicitis

Abstract

DURING the past few years we have encountered a large number of adult patients on whom an appendectomy had been performed for so-called chronic appendicitis, without relief of their symptoms. The histories in these cases were so striking that they left considerable doubt in one's mind as to the real necessity for the operative procedure. Although it is well known that this situation exists, it is not usually accorded the serious consideration it deserves. However, it seems apparent from our study that the indiscriminate removal of the so-called appendices of the chronic type has become much more prevalent than has hitherto been recorded. The unwarranted removal of the appendix for vague abdominal symptoms is of such common occurrence that it should be discouraged by both the internist and surgeon. The roentgenologist is not altogether blameless in this regard, for too often a roentgenologic diagnosis of chronic appendicitis is made and the patient is rushed to the surgeon, who removes the appendix without further considering the possibility of other conditions which may be responsible for the gastro-intestinal disturbance. Unfortunately, the surgeon is not aware of the large number of cases—their numbers are increasing—that return unrelieved to the internist or gastro-enterologist. Many patients, especially those of a neurotic tendency, even find themselves in a worse state, and are much more difficult to control than if they had not been operated upon. Hunner (1) adequately expresses the opinion of many observers on this subject, stating: “The formula to operate first, then investigate, is a formula in which there is absolutely no defense when dealing with so-called chronic appendicitis, a diagnosis which has led to more useless operations than any other in the category of abdominal surgery.” An attempt will be made in this presentation to demonstrate that in a vast number of cases a thorough roentgenologic investigation of the digestive and urinary tracts will undoubtedly materially reduce the number of patients operated upon for so-called chronic appendicitis. In a large percentage of instances the true nature of the gastro-intestinal or other abdominal conditions will be correctly diagnosed by means of this procedure. Our experience has shown that the diagnosis of chronic appendicitis is often very difficult, and it behooves one to be extremely cautious in arriving at such a diagnosis without a painstaking examination. It is far better to make innumerable unnecessary investigations than to have a patient subjected to a useless and often harmful operation. The roentgen method of diagnosis of chronic appendicitis will not be considered in this communication. It is not to be inferred, however, that the x-ray diagnosis can be arrived at without difficulty nor is it a method of choice in the examination.