Abstract
BackgroundParadigm shift toward nonoperative management (NOM) of adult appendicitis has made computed tomography (CT) more important than ever, particularly in differentiating complicated from uncomplicated disease. Complete surgical and pathological data of appendicitis in a place where appendectomy at initial admission is a standard of care would allow retrospective review of preoperative CT for performance and predictive ability in identifying those that may benefit from NOM in the future.ResultsThe study included 201 CT scans of consecutive adult patients who presented for appendectomy at initial admission with pathologically confirmed acute appendicitis. Complicated appendicitis referred to gangrene or perforation on pathological or operative findings. The overall CT sensitivity, specificity and accuracy for differentiation of complicated from uncomplicated appendicitis were 87.2%, 75.7% and 81.1%, respectively. The most sensitive CT findings of complicated appendicitis were mucosal enhancement defect (83.2%; 95% CI 74.1–90.0) and moderate-to-severe periappendiceal fat stranding (96.8%; 95% CI 91.1–99.3), both independently predictive of complicated appendicitis with adjusted odds ratios (ORs) of 4.62 (95% CI 1.86–11.51) and 4.41 (95% CI 1.06–18.29), respectively. Phlegmon, fluid collection, extraluminal appendicolith, periappendiceal air and small bowel dilatation had specificity of 98.1–100%. Intraluminal appendicoliths were found more frequently in complicated appendicitis (52.6% vs. 22.6%) but not predictive for this diagnosis. Independent clinical predictors of complicated appendicitis were lack of pain migration (OR 2.06), neutrophilia ≥ 82% (OR (2.87) and symptoms ≥ 24 h (OR 5.84).ConclusionsCT findings were highly accurate in differentiating complicated from uncomplicated appendicitis among patients undergone appendectomy at initial admission.
Highlights
Paradigm shift toward nonoperative management (NOM) of adult appendicitis has made computed tomography (CT) more important than ever, in differentiating complicated from uncomplicated disease
Strategies for imaging patients with suspected appendicitis usually revolve around clinical probability of the disease, in which—if imaging is to be performed—this may start with CT first, or US first with conditional CT when US is inconclusive [5]
The final study population comprised of 201 patients (Fig. 1), which met the sample size calculated initially based on prevalence of complicated appendicitis of at least 25% with 95% confidence interval and 6% allowable error
Summary
Paradigm shift toward nonoperative management (NOM) of adult appendicitis has made computed tomography (CT) more important than ever, in differentiating complicated from uncomplicated disease. Cross-sectional imaging is a very useful noninvasive method for the evaluation of patients suspected of having acute appendicitis as history and physical examination may not be specific. Strategies for imaging patients with suspected appendicitis usually revolve around clinical probability of the disease (using one of many available clinical prediction/decision rules), in which—if imaging is to be performed—this may start with CT first, or US first with conditional CT when US is inconclusive [5]. For the rest of population, CT is often considered the most appropriate first imaging test owing to its high accuracy for both diagnosis, characterization of appendicitis and strong ability to suggest alternative diagnosis [4], but value of the US-first strategy with conditional CT or even US re-evaluation after an equivocal CT cannot be understated [5, 6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
