Focal appendicitis confined to the tip: diagnosis at US.

Lim, Hyo Keun; Lee, W J; Lee, S J; NamGung, Seong-Eun; Lim, Jihyun

doi:10.1148/radiology.200.3.8756934

Cited by 67 publications

(25 citation statements)

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“…The finding of an appendicolith on preoperative CT scans in adult acute appendicitis is less prevalent than in children: The rate was 1 in 500 patients in one large clinical series of surgically proven cases. 2 Several experimental animal studies were conducted in an attempt to determine the role of stones left in the peritoneal cavity. 3,4 Sterile gallstones showed no evidence of intra-abdominal abscess after 16 weeks of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Extraluminal Appendicolith: An Indication for Interval Appendectomy with Intraoperative Localization and Removal of That Potential Cause of Intra-Abdominal Abscess

Itah

Skornick

Greenberg

2008

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Appendicoliths are formed by calcium salts and fecal debris layered and lodged within the appendix. They are detected on unenhanced X-rays in <10% of patients with appendicitis. When an appendicolith is found extraluminally, it is pathognomonic for perforation of the appendix. Moreover, retained appendicoliths are likely to be infected and to be the source of a postoperative intraperitoneal abscess, whereupon the only definitive treatment is surgical excision. In this paper, we describe an asymptomatic patient with evidence of an extraluminal appendicolith on computed tomography following successful conservative treatment for a periappendicular abscess. She underwent a laparoscopic interval appendectomy that included the removal of an extraluminal appendicolith and was released home on the following day. We advocate this approach in order to prevent the possible formation of an intra-abdominal abscess caused by an infected nidus.

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Section: Discussionmentioning

confidence: 99%

Extraluminal Appendicolith: An Indication for Interval Appendectomy with Intraoperative Localization and Removal of That Potential Cause of Intra-Abdominal Abscess

Itah

Skornick

Greenberg

2008

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…When this occurs, the proximal portion of the appendix may be normal in caliber and nonenhancing, which can lead to false negative interpretations with both US and CT [28]. Care must be taken to inspect the entire length of the appendix to avoid this pitfall.…”

Section: Localized Appendicitismentioning

confidence: 99%

The use of advanced imaging for appendicitis in children

John

2000

Emergency Radiology

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Improved resolution of late-generation CT and US technology has fostered an increased reliance on imaging for the preoperative diagnosis or exclusion of appendicitis. Both modalities have been shown to have a high accuracy rate, but certain diagnostic challenges persist. CT has largely replaced US for the diagnosis of appendicitis in adults, but the modality of choice is less clear in children. US is usually more easily and rapidly performed in young patients, obviating the need for contrast administration and sedation. Ionizing radiation exposure is avoided with US. Assessment of physical signs and symptoms can be achieved while performing US, an advantage over CT. However, US is best interpreted during performance of the examination, and thus CT is often favored when the interpreter is in a remote location. Strategies using limited CT to follow an indeterminate US show high diagnostic accuracy. This article discusses the controversy surrounding the optimal imaging approach to acute abdominal pain in children and illustrates some of the challenges encountered with US and CT for the evaluation of appendicitis.

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“…8 The importance of Ultrasonography (USG) as a diagnostic tool for appendicitis has been widely known and studied. [9][10] Various scores combining clinical features and laboratory investigations, have also been developed to reach the diagnosis, such as the Alvarado score and the Modified Alvarado score. 11,12 However, till now there is no confirmatory laboratory marker for the pre-operative diagnosis of acute appendicitis and appendicular perforation.…”

Section: Introductionmentioning

confidence: 99%

Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study

et al. 2017

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Background: Appendicitis is the most common acute abdominal condition requiring emergency surgery, with a lifetime risk of 6%. Appendectomy continues to be one of the commonest procedures in general surgery, accounts for approximately 1% of all surgical operation. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%). The aim of this study was to whether Serum Bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about complicated appendicitis.Methods: This was prospective observational study done in Mahatma Gandhi Medical College and Research Institute, Pondicherry between November 2014 and August 2016. About 110 patients of acute appendicitis who had undergone appendicectomy were studied. Data was collected and analyzed critically.Results: Males 66 (60%) outnumbered females 44 (40%) and overall mean age was 26.61±12.37 years. Of the 110 patients, 9% were normal appendix, 59.09% were confirmed as acute appendicitis while 31.81% were diagnosed with complicated appendicitis on biopsy. The Sensitivity and Specificity of serum bilirubin as a marker in predicting Acute appendicitis and complicated appendicitis was 47.6% and 90.9% respectively. Similarly, the Positive predicative value and Negative predicative value for the same was 88.5% and 61.5% respectively with odds ratio 12.4 with significant p value <0.0001.Conclusions: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia should be identified as having a higher probability of complicated appendicitis. Hence, serum bilirubin levels have a predictive potential for the diagnosis of severity of acute appendicitis and need for early appendicectomy. If total serum bilirubin is added to already existing laboratory tests, then the diagnosis of complicated appendicitis in clinically suspected cases can be made with fair degree of accuracy, the need for CECT and MRI can be reduced and unnecessary delay in appendicectomy can be avoided.

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Focal appendicitis confined to the tip: diagnosis at US.

Abstract: Although US appears to be fairly accurate in the diagnosis of focal appendicitis confined to the tip, the entire length of the appendix should be evaluated in order to avoid a false-negative diagnosis.

Cited by 67 publications

References 0 publications

Extraluminal Appendicolith: An Indication for Interval Appendectomy with Intraoperative Localization and Removal of That Potential Cause of Intra-Abdominal Abscess

Extraluminal Appendicolith: An Indication for Interval Appendectomy with Intraoperative Localization and Removal of That Potential Cause of Intra-Abdominal Abscess

The use of advanced imaging for appendicitis in children

Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study

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