Assessment of the persistence of fecal loading in the cecum in presence of acute appendicitis

Abstract

Objective Although the radiographic characteristics of acute appendicitis have been well documented, the value of plain abdominal radiography has not been completely studied. Therefore, the purpose of this investigation was to establish the association and relevance of the image of fecal loading in the cecum detected by plain abdominal X-ray of patients with acute appendicitis. Methods One hundred and seventy consecutive patients of both sexes were admitted at the hospital with acute pain in the right flank. The hypothesis of appendicitis was confirmed by operation and histological examination. These patients were distributed into two groups: Group 1 ( n = 100), patients who had plain abdominal X-rays done a few hours before surgical treatment, and Group 2 ( n = 70), patients who had plain abdominal X-rays done before the surgical procedure and also the following day. All X-rays were taken from an anteroposterior view of the abdomen. Demographic data such as age, gender, and skin color (white, brown and black) and morphologic stages of acute appendicitis were also assessed. Results Radiographic sign of fecal loading in the cecum was detected in 97 (97%) patients of Group 1 and in 68 (97.14%) patients of Group 2. This sign could not be detected any longer after surgery in 66 of the 68 positive cases. Sensitivity of this radiographic sign for acute appendicitis was 97.05%. Conclusions Radiographic image of fecal loading in the cecum of patients with abdominal pain is associated with acute appendicitis. The image usually becomes undetectable shortly after the appendix removal.