Diagnosis of Appendicitis – Role of CT Scan in Ultrasound Negative Patients
Authors/Creators
- 1. Assistant Professor, Department of Radiology, Prathima Relief Institute of Medical Sciences, Mulugu Road, Hanamkonda, Telangana State
- 2. Associate Professor, Department of Radiology, Prathima Relief Institute of Medical Sciences, Mulugu Road, Hanamkonda, Telangana State
Description
Background: Acute appendicitis ranks among the most frequent causes of acute abdominal emergencies, making accurate diagnosis and timely surgery essential. Ultrasonography (US) and computed tomography (CT) are pivotal in achieving accurate diagnoses for this condition. This study aimed to evaluate the accuracy of CT in identifying appendicitis in ultrasound-negative cases and to assess the efficacy of CT in identifying complications of appendicitis. Methods: The study included patients aged 15 – 50 years, who were admitted to the surgical emergency ward with clinical symptoms suggestive of acute inflammation, such as right iliac fossa pain, fever, and vomiting. A total of fifty patients were selected as the study sample. Detailed clinical history was recorded using the prescribed proforma. Informed consent was obtained from all participating patients, and the study protocol was approved by the institutional ethical committee. Among the participants, 32 patients with either negative ultrasound findings or equivocal results underwent CT examination to obtain further diagnostic information. Results: The examination of the position of the appendix on CT scan showed 78% of cases having retrocaecal appendix followed by the pelvic position in 14%, pre, and post-ileal in 6% of cases, and the rest in 2% of cases. The existence of free fluid was in 18% of cases, mesenteric lymphadenitis in 26% of cases, and normal appearance in 56% of cases. In this study, 38% of the study group has appendicitis, diagnosed by Computed Tomography. The age group 20-24 years has a higher incidence of acute appendicitis. Shows 6% of patients among the study population with free fluid in the Right iliac fossa show appendicular perforation/abscess. Conclusion: CT plays a more precise role in diagnosing appendicitis, especially in cases where ultrasound results are negative. Although the role of ultrasound cannot be underrated as being non-invasive, having a quick acquisition time, being relatively cost-effective, and most importantly, not requiring the use of ionized contrast agents or oral preparation, thus eliminating radiation exposure. The CT scan can as a second-line investigation with higher significant sensitivity, specificity, positive predictive value, and negative predictive value.
Abstract (English)
Background: Acute appendicitis ranks among the most frequent causes of acute abdominal emergencies, making accurate diagnosis and timely surgery essential. Ultrasonography (US) and computed tomography (CT) are pivotal in achieving accurate diagnoses for this condition. This study aimed to evaluate the accuracy of CT in identifying appendicitis in ultrasound-negative cases and to assess the efficacy of CT in identifying complications of appendicitis. Methods: The study included patients aged 15 – 50 years, who were admitted to the surgical emergency ward with clinical symptoms suggestive of acute inflammation, such as right iliac fossa pain, fever, and vomiting. A total of fifty patients were selected as the study sample. Detailed clinical history was recorded using the prescribed proforma. Informed consent was obtained from all participating patients, and the study protocol was approved by the institutional ethical committee. Among the participants, 32 patients with either negative ultrasound findings or equivocal results underwent CT examination to obtain further diagnostic information. Results: The examination of the position of the appendix on CT scan showed 78% of cases having retrocaecal appendix followed by the pelvic position in 14%, pre, and post-ileal in 6% of cases, and the rest in 2% of cases. The existence of free fluid was in 18% of cases, mesenteric lymphadenitis in 26% of cases, and normal appearance in 56% of cases. In this study, 38% of the study group has appendicitis, diagnosed by Computed Tomography. The age group 20-24 years has a higher incidence of acute appendicitis. Shows 6% of patients among the study population with free fluid in the Right iliac fossa show appendicular perforation/abscess. Conclusion: CT plays a more precise role in diagnosing appendicitis, especially in cases where ultrasound results are negative. Although the role of ultrasound cannot be underrated as being non-invasive, having a quick acquisition time, being relatively cost-effective, and most importantly, not requiring the use of ionized contrast agents or oral preparation, thus eliminating radiation exposure. The CT scan can as a second-line investigation with higher significant sensitivity, specificity, positive predictive value, and negative predictive value.
Files
IJPCR,Vol15,Issue8,Article2.pdf
Files
(405.8 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:000626463d24e68fb44ff45d87f71b44
|
405.8 kB | Preview Download |
Additional details
Dates
- Accepted
-
2023-07-30
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue8,Article2.pdf
- Development Status
- Active
References
- 1. Shogilev DJ, Duus N, Odom SR, et al. Diagnosing appendicitis: an evidence-based review of the diagnostic approach in 2014. Western Journal of Emergency Medicine. 2014;15(7):859-71. 2. Wagner M, Tubre DJ, Asensio JA. Evolution and current trends in the management of acute appendicitis. Surg Clin North Am. 2018; 98(5):1005-23. 3. Snyder MJ, Guthrie M, Cagle S. Acute appendicitis: efficient diagnosis and management. Am Fam Physician. 2018; 98(1):25-33. 4. Lee JH, Jeong YK, Park KB, et al. Operatordependent techniques for graded compression sonography to detect the appendix and diagnose acute appendicitis. Am J Roentgenol. 2005; 184(1):91-97. 5. Hernanz-Schulman MCT. CT and US in the diagnosis of appendicitis: an argument for CT. Radiology. 2010;255(1):3-7. 6. Salwe NA, Kulkarni PG, Sinha RS. Study of morphological variations of vermiform appendix and caecum in cadavers of western Maharashtra region. Int J Advanced Physiology Allied Sci. 2014;2(1):31-41. 7. Ghorbani A, Forouzesh M, Kazemifar AM. Variation in anatomical position of vermiform appendix among Iranian population: an old issue which has not lost its importance. Anatomy Research International. 2014; 313575. 8. Kim K, Kim YH, Kim SY. Low-dose abdominal CT for evaluating suspected appendicitis. The New England Journal of Medicine. 2012;366(17):1596-1605. 9. Des Plantes CMP, van Veen MJF, der Palen JV, et al. The effect of unenhanced MRI on the surgeons decision-making process in females with suspected appendicitis. World J Surg. 2016;40(12):2881-2887.10. Hernanz-Schulman MCT. CT and US in the diagnosis of appendicitis: an argument for CT. Radiology. 2010;255(1):3-7. 11. N P. Leite, J M. Pereira, Rui Cunha, P. Pinto, C Sirlin. CT Evaluation of Appendicitis and Its Complications: Imaging Techniques and Key Diagnostic Findings. American Journal of Roentgenology AJR. 2005; 185:406–417. 12. Al-Ajeraemi Y. Sensitivity and specificity of ultrasound in the diagnosis of acute appendicitis. East Mediterr Health J. 2012; 18(1):66-69. 13. Raval MV, Deans KJ, Rangel SJ, et al. Factors associated with imaging modality choice in children with appendicitis. J Surg Res. 2012; 177(1):131-136. 14. Monajemzadeh M, Hagghi-Ashtiani MT, Montaser Kouhsari L, et al. Pathologic evaluation of appendectomy specimens in children: is routine histopathological examination indicated? Iran J Pediatr. 2011; 21(4):485-490. 15. Al-Khayal KA, Al-Omran MA. Computed tomography and ultrasonography in the diagnosis of equivocal acute appendicitis. A meta-analysis. Saudi Med J. 2007;28(2):173- 180. 16. Pipal DK, Kothari S, Shrivastava H, et al. To evaluate the diagnostic accuracy of Alvarado score, C- reactive protein, ultrasonography, and computed tomography in acute appendicitis and to correlate them with operative and histological findings. Int Surg J. 2017; 4(1): 361-367. 17. Noguchi T, Yoshimitsu K, Yoshida M. Periappendiceal hyperechoic structure on sonography: a sign of severe appendicitis. Journal of Ultrasound in Medicine. 2005; 24(3):323-327. 18. Terasawa T, Blackmore CC, Bent S, et al. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 2004; 141(7):537-546. 19. Doria AS, Moineddin R, Kellenberger CJ, et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology. 2006; 241(1):83-94.