Abstract
Acute appendicitis is one of the most frequent causes of lower abdominal pain and requires immediate surgical intervention. The diagnosis often poses a lot of challenge even to experienced surgeon. Those patients with equivocal symptoms may require different imaging modalities like radiography, contrast examination and ultrasound with limited utility. Multidetector computed tomography (MDCT) used in suspected acute appendicitis has, however, resulted in improved diagnostic accuracy and also reduction of negative surgeries.ObjectiveWe intend to determine the diagnostic efficiency of MDCT in clinically equivocal cases of acute appendicitis correlating it with surgical/histopathological findings.Materials and methodsA group of 116 patients was included in this study. Spiral MDCT was performed in all these cases after administration of oral and intravenous contrast. All these patients underwent surgery and the CT findings were correlated with histopathology. Out of these 116 patients, 60 patients were male and 56 female. The age range was from three to seventy years and mean age was 28+1 years.ResultsThe results proved that MDCT had a sensitivity of 97.5%, specificity of 97.0%, and accuracy of 97.4% for the diagnosis of appendicitis with one false positive and two false negative cases. The study showed 100% accuracy in diagnosing acute appendicitis in children. In 33 patients, an alternate cause was identified with CT. The alternate diagnosis made on CT findings was consistent with the final diagnosis in 27 (81.8%) of 33 patients in whom there was no evidence of acute appendicitis. The clinical diagnosis disagreed with the CT diagnosis in six patients (18.18%).ConclusionOur study verifies that MDCT plays an important role in evaluation and consequent management of equivocal cases of acute appendicitis. MDCT is also able to diagnose appendicitis or detect alternative diagnosis in pediatric population.
Highlights
Acute appendicitis is one of the most frequent causes of lower abdominal and right lower quadrant pain
The results proved that Multidetector computed tomography (MDCT) had a sensitivity of 97.5%, specificity of 97.0%, and accuracy of 97.4% for the diagnosis of appendicitis with one false positive and two false negative cases
The study showed 100% accuracy in diagnosing acute appendicitis in children
Summary
Acute appendicitis is one of the most frequent causes of lower abdominal and right lower quadrant pain. The diagnosis often poses a lot of challenge even to experienced surgeon as several other gynecological, gastrointestinal and genitourinary conditions can have similar presentation [1,2] Those patients with equivocal symptoms and without acute appendicitis could be spared of unnecessary cost and of the associated morbidity of surgery if proper imaging and appropriate evaluation were done beforehand. The clinical diagnosis of acute appendicitis has around 20% false-positive and a similar falsenegative error rate [5, 6] These patients will have equivocal clinical findings and/or laboratory test results making the diagnosis difficult [7,8,9]. Multidetector computed tomography (MDCT) used in suspected acute appendicitis has, resulted in improved diagnostic accuracy and reduction of negative surgeries [10,11]
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