Diagnostic Efficiency of Multidetector Computed Tomography in the Evaluation of Clinically Equivocal Cases of Acute Appendicitis with Surgical Correlation

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.

Türkiye’nin doğusunda perfore apandisit oranı dizinin aksine kız çocuklarda neden daha yüksek?

“…Accurate diagnosis is made only with a rate of 72–94%. These rates show that surgeons still have difficulty in diagnosing appendicitis (6, 12). Therefore, a detailed physical examination should be performed and appendicitis should be considered primarily in the differential diagnosis in all patients presenting to the emergency department with abdominal pain.…”

Đặc Điểm Hình Ảnh Và Giá Trị Của Cắt Lớp Vi Tính Đa Dãy Trong Chẩn Đoán Viêm Ruột Thừa Cấp

“…Viêm ruột thừa cấp (VRTC) là một trong những nguyên nhân thường gặp nhất gây đau bụng vùng hạ vị và hố chậu phải [1]. Ở Việt Nam, VRTC chiếm 53,38% các trường hợp mổ cấp cứu bụng tại Bệnh viện Việt Đức [2].…”

Demonstration of tissue and peripheral blood eosinophils in patients with acute appendicitis

“…A tiny finger-like blind-ended tube called the vermiform appendix connects to the cecum (Faisal et al, 2022) Which is arise from posteromedial wall of caecum about 2cm below the ileocecal junction and has no constant position (Iqbal et al, 2018, Alraddadi, 2021. Base of appendix has constant relationship with caecum, but the location of the tip was changeable (Iqbal et al, 2012, Gali et al, 2022. The length of a normal appendix varies between 6 to 9 cm (Ekici et al, 2018) as well as it might range between 2 to 20 cm (Schumpelick et al, 2000, Deshmukh et al, 2014.…”