Patients with CT results suggestive of appendicitis but who have normal clinical presentation should probably proceed to appendectomy sooner to avoid it later, concludes a large retrospective study from the University of California, San Francisco (UCSF).
The study, released May 26 in Radiology online, examined the CT records of 2,283 patients (856 men, 1,427 women; ages 18-99 years; mean age, 46) who underwent CT for suspected appendicitis between 2002 and 2007.
"We wanted to look at patients with a positive CT scan but atypical clinical symptoms who did not have their appendix immediately removed," study co-author Dr. Emily Webb, assistant professor of clinical radiology at UCSF, said in a statement accompanying the study's release.
Over the six-year study period, a total of 516 (23%) of the cohort had CT findings indicating probable or definite appendicitis. Of these, 450 (87%) underwent appendectomy within four days, and 95% of the surgical cases were confirmed as acute appendicitis.
An additional 49 (10%) of the 516 patients had nonsurgical treatment that included antibiotics or percutaneous abscess drainage.
Thirteen of the 516 patients didn't undergo immediate appendectomy because their normal presentation (normal appetite, absence of nausea and vomiting, normal white blood cell count, and mild or resolving pain) was atypical for acute appendicitis.
However, five (38%) of these patients ended up having their appendix removed when symptoms recurred within four months -- all of which were confirmed as appendicitis.
"The results ... confirm that CT is a good diagnostic tool for appendicitis and that surgeons should be wary of dismissing positive findings," Webb said. "Prompt treatment of chronic or recurrent appendicitis can prevent patients from developing complications or other future ill effects."
The findings may also help explain the disparity between CT results that indicate appendicitis and a lack of clinical symptoms, the researchers added.
The delayed cases are not necessarily acute; when the appendix is not completely obstructed, it can result in a milder form of appendicitis that is chronic or recurring, but these three forms of appendicitis are indistinguishable on CT, Webb said.
By Eric Barnes
AuntMinnie.com staff writer
May 27, 2010
Related reading
Large study confirms CT's accuracy for acute appendicitis, May 20, 2010
Preoperative CT may reduce negative appendectomies in women, January 28, 2010
Noncontrast CT accurately diagnoses acute appendicitis in adults, January 25, 2010
Limit CT exams for appendicitis in kids, November 24, 2009
Feel-good CT-positive appendicitis cases rarely elude surgery, January 12, 2009
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