Prophylactic appendectomy: unnecessary in children with incidental appendicoliths detected by computed tomographic scan

Abstract

Purpose Controversy exists regarding the clinical significance of an isolated appendicolith on computed tomographic (CT) scan. We sought to determine the risk of developing appendicitis in children with an incidentally noted appendicolith. Methods We retrospectively reviewed all pelvic CT scans in patients 18 years or younger at a tertiary care children's hospital from October 2005 to September 2008. Patients with an appendicolith and no radiographic evidence of acute appendicitis were selected for further review. Written questionnaire and telephone follow-up were attempted in all patients. Results Two thousand nine hundred thirteen pelvic CT scans were performed during the study period. The incidence of an isolated appendicolith during the study period was 2.6% (n = 75). Seven patients underwent appendectomy at initial presentation. Nine children underwent appendectomy subsequently: 3 electively and 6 at the time of return with abdominal pain. Only 6 of these 16 appendectomy specimens had histologic evidence of appendicitis, whereas only 3 demonstrated an appendicolith. Subsequent appendicitis developed in 5.8% (n = 4) of patients with an isolated appendicolith. Follow-up was achieved in 50% of patients who did not have an appendectomy (median, 2.8 years). Conclusion Children with an incidental appendicolith are at low risk for developing appendicitis. The appendicoliths were often a transient finding not confirmed on surgical pathologic condition or subsequent imaging.