Beyond the commonest: right lower quadrant abdominal pain is not always appendicitis

Abstract

ABSTRACT Background Despite acute appendicitis is the most common underlying etiology of the acute abdomen, a considerable list of other pathologies should be considered; despite sharing almost the same clinical presentation. This study aimed to re-enhance the importance and sensitivity of CT scan as a solitary imaging tool, in the evaluation of patients with acute right lower abdominal pain. Patients and methods It is a retrospective study of the last 1000 patients, referred with acute right lower abdominal pain for CT scan examination. Biphasic CT scan abdomen protocol was applied for all. Results Cecal carcinoma was detected in three patients (0.3%), epiploic appendicitis in five (0.5%), omental infarct in two (0.2%), appendicular mucocele in two (0.2%), appendicular NET in one (0.1%), cecal diverticulitis in four (0.4%), Chron’s disease in six (0.6%), intussusception in one (0.1%) and FB in one (0.1%) and appendicular perforation in one (0.1%), acute simple appendicitis 398 (39.8%) and 577 (57.7%) were unremarkable. Conclusion Despite acute appendicitis is the most common cause of the acute abdomen, many other surgical and non-surgical etiologies should also be considered, with a higher sensitivity of CT as a solitary diagnostic tool of imaging.