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PubMed2002

Human cytokine levels in nonperforated versus perforated appendicitis: molecular serum markers for extent of disease?

Appendicitis is a common surgical problem that is associated with a systemic inflammatory response. Previous studies have shown that cytokines are activated early in acute inflammation and sepsis and may serve as indicators of clinical severity. In this study we examined the role of cytokines as serum markers to distinguish nonperforated versus perforated appendicitis. Patients with the presumptive diagnosis of appendicitis had serum drawn preoperatively. Only patients (n = 59) with an intraoperative diagnosis of nonperforated (n = 34) and perforated (n = 25) appendicitis had serum drawn 12 hours postoperatively. Diagnosis was later confirmed by pathologic examination. The serum specimens were batch analyzed using enzyme-linked immunosorbent assays specific for interleukin (IL)-1beta, IL-2, IL-6, IL-8, and IL-10. Serum from normal healthy subjects served as control specimens (n = 9). Patients in the nonperforated and perforated groups were similar with regard to age, gender, race, white blood cell count, and fever. All cytokine levels including preoperative, postoperative, nonperforated, and perforated were higher in patients with appendicitis as compared with controls. IL-1beta, IL-2, and IL-10 levels were not different between groups with appendicitis. Preoperative serum levels of IL-6 (P = 0.036) and IL-8 (P = 0.047) were higher in patients with perforated versus nonperforated appendicitis. In addition postoperative serum levels of IL-6 (P = 0.0001) remained higher in the perforated group versus the nonperforated group. Serum levels of IL-6 and IL-8 may have a role in discerning the extent of disease in this condition. This initial step in systemically studying the role of cytokines in this disease may ultimately lead to the development of molecular indicators to aid in diagnosis and differentiate appendicitis from other conditions.

Adult↗
PubMed2002

[Uncommon clinical aspects of appendicitis].

During the period between 1980-2000 at the authors department 5114 children with acute appendicitis were operated (on average 245 per year). From this period the year 1999 was selected when 160 children were operated on account of acute appendicitis. Thirty-eight children had an advanced finding--gangrenous appendicitis or an abscess. Gangrenous appendicitis or empyema of the appendix without perforation were recorded in 16 patients (10%), gangrenous appendicitis with perforation in 9 patients (5.6%), a periappendicular abscess in 13 (8.1%), phlegmonous appendicitis was recorded in 108 patients (67.5%) and in 14 patients the histological examination revealed mesenterial lymphadenitis (8.7%). The authors demonstrate on selected case-histories the problem of appendicitis not recognized in time and appendicitis with an atypical course. They draw attention to the uncommon clinical course in 5 patients where at first a tumour of the upper mediastinum, tumour of the abdominal cavity, twice diarrhoeal disease and a tumour in the lesser pelvis was suspected. The authors emphasize that even at a time when special examinations are available (ultrasonography, computed tomgraphy) it is important to make repeated clinical examinations of the patients at least in the course of three days.

Acute Disease↗
PubMed2002

Mast cell density, neuronal hypertrophy and nerve growth factor expression in patients with acute appendicitis.

In acute appendicitis, although the relationship between the enteric nervous system (ENS) and mast cells (MCs) has been described in a few studies, neither the expression of nerve growth factor (NGF) nor its relation to mast cell density (MCD) and ENS has been delineated yet in this disease. The aim of this study was to immunohistochemically investigate the relationship between MCD, nervous system and NGF expression in the appendices of cases with clinically and histopathologically diagnosed acute appendicitis and of normal controls. Twenty-five patients with acute appendicitis and twelve normal controls were included in our study. Mast cell tryptase, PGP 9.5 and anti-NGF immunostained tissue sections were subjected to quantitative image analysis. Our results showed that MCD, the number of Schwann cells, the number and size of ganglia and NGF staining were significantly greater in acute appendicitis than in the control group (p < 0.01). A strong correlation between MCD and NGF staining was detected (r = 0.92) only in cases with acute appendicitis. Similarly MCD was also related to neuronal proliferation and hypertrophy in this group. We failed to detect any relationship between NGF staining and neural components either in the acute appendicitis or control groups. Our findings indicate that mast cells could be one of the important cell populations responsible for nerve proliferation and hypertrophy in acute appendicitis. The relationship between NGF staining and MCD and the lack of correlation between NGF staining and changes in neural components suggest that, in acute appendicitis, NGF might be responsible for the increased number of MCs, but not for neuronal proliferation and hypertrophy.

Acute Disease↗
PubMed2003

Ultrasonography for the diagnosis of acute appendicitis.

Acute appendicitis is usually encountered clinically as acute abdomen. Typical cases are easy to diagnose, but it can sometimes be very difficult to make a diagnosis in atypical cases. We retrospectively studied patients who underwent ultrasonography for right-sided lower abdominal pain suggesting acute appendicitis, and assessed the accuracy of ultrasonic diagnosis. The subjects were 202 patients (100 males and 102 females) aged 6-89 years (mean: 33.3 years). From the ultrasonic findings, appendicitis was classified as follows: 1) catarrhal: a clear layer structure of the appendiceal wall and mucosal edema; 2) phlegmonous: an ill-defined layer structure of the appendiceal wall, moderate enlargement of the apendix, and maximum transverse dimension of > or = 10 mm; and 3) gangrenous: unidentifiable layer structure of the appendiceal wall and marked enlargement to form a mass. The appendix was visualized in 142 of the 202 patients (70.3 %). When the appendix was detected, the sensitivity, specificity and accuracy of ultrasound for making a diagnosis of appendicitis were 97.6%, 82.0 %, 91.5 %, respectively. With regard to assessment of the severity of inflammation, ultrasonic and histologic findings were concordant in 61.2 % of the patients. However, ultrasound was shown to possibly underestimate the extent of inflammation. On the other hand, 11 of the 60 patients with an undetectable appendix (18.3 %) were clinically diagnosed as having appendicitis. The pathologic diagnosis was catarrhal appendicitis in 3 patients and phlegmonous appendicitis in 8 patients. In patients with an undetectable appendix, the possibility of catarrhal or phlegmonous appendicitis should be kept in mind.

Abdomen, Acute↗
PubMed2004

Exploratory laparoscopy at suspicion of acute appendicitis. Review.

Exploratory laparoscopy has been used since 1910 and is one of the new tools for diagnosing appendicitis on a routine basis. It can be looked upon as "semi-invasive" in comparison to on one hand ultrasonography/CT/MRI and on the other open laparotomy. According to the literature, mostly in retrospective studies, laparoscopy might reduce the frequencies of unnecessary appendectomies in 20-30 percent and an accuracy of diagnosis of appendicitis of 95-99 percent. This means that laparoscopy has a sensitivity of 92 percent in diagnosing acute appendicitis, including all cases of mucosal inflammation only. This means, however, that about one in 11 appendicitis is missed and it is still a question as to whether an appendix that looks normal at laparoscopy for acute right iliac fossa pain should be removed, or whether if it is not removed, there is a risk of missing an early case of appendicitis later leading to perforation and peritonitis? Mucosal inflammation obviously can never be determined in the appendix is left in place. However, a summery of available data seems to favour that it is distinctly uncommon that explorative laparoscopy misses any acute appendicitis that requires appendectomy. If there are cases of acute appendicitis not requiring appendectomy can only be known in prospective studies. A Cochran review was published in early 2002 and analysed 45 randomized trials, 39 of which had been carried out in adults, comparing both therapeutic and diagnostic outcomes of patients undergoing open or laparoscopic surgery for suspected appendicitis. Diagnostic outcomes favoured the laparoscopic approach in that both the negative appendectomy rate and "the frequency of an unestablished diagnosis" were reduced, most significantly in women in their reproductive years. However, in the conclusion the authors sounded a note of caution about the quality of some of the research data they had analysed, and recommended that more blinded studies be performed. Because there is a belief that laparoscopic appendectomy is less likely to cause intraperitoneal adhesions than open surgery, they also recommended longer follow-up studies to assess the relative incidences of obstruction due to adhesions resulting from the two techniques. Therefore, the conclusion can be drawn that in all equivocal cases laparoscopy is better than laparotomy as the initial step in year 2003. However, there is still a lack of data comparing non-invasive modern techniques such as ultrasonography and CT with laparoscopy, and the value of laparoscopy after the best available ultrasonography or CT.

Acute Disease↗
PubMed1992

Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance.

Debate continues as to what should be the appropriate "negative" appendectomy rate for patients suspected of having acute appendicitis. The controversy centers around balancing the complications of appendectomy for a normal appendix with those for a perforated appendix. By using a decision analysis approach to the probable outcomes of appendectomy for a normal appendix, acute appendicitis, and perforated appendicitis, this study provides one answer to this question. These outcomes are based on a review of the results of over 10,000 appendectomies. There is an inverse relationship between the normal appendectomy rate and perforated appendicitis rate. The overall complication rate in patients suspected of having appendicitis improved when the rate of perforated appendicitis was lowered, even if this meant raising the negative appendectomy rate. The perforation rate seemed to level off at approximately 10 per cent. The quality of surgical care delivered to a given population should not be judged solely on the normal appendectomy rate, but this rate should be interpreted in the light of the perforated appendicitis rate. Quality assurance assessments should focus first on perforated appendicitis and only later on normal appendectomy.

Appendectomy↗
PubMed2005

Role of leukocyte count, neutrophil percentage, and C-reactive protein in the diagnosis of acute appendicitis in the elderly.

Leukocyte count, neutrophil percentage, and C-reactive protein (CRP) have been shown to give valuable information in the diagnosis of acute appendicitis. However, whether these laboratory tests have the same clinical applicability in the elderly as in young patients remains unclear. This retrospective study aimed to clarify the role of these tests in the diagnosis of acute appendicitis in patients aged 60 years or over. Eighty-five consecutive elderly patients underwent appendectomy for suspected acute appendicitis during a 30-month period. Histologically verified appendicitis was found in 77 of the 85 patients (90.6%). There was no significant difference in leukocyte counts or CRP values between patients with acute appendicitis and those with a normal appendix. The sensitivities of leukocyte count, neutrophil percentage, and CRP in the diagnosis of acute appendicitis were 71.4 per cent, 88.3 per cent, and 90 per cent, respectively, while the specificities were 37.5 per cent, 25 per cent, and 37.5 per cent, respectively. Of 77 patients with acute appendicitis, only two had all three tests simultaneously normal. In conclusion, patients with normal results in all three tests are highly unlikely to have acute appendicitis and should be evaluated with extra caution before surgery.

Acute Disease↗
PubMed1992

Selective versus routine antibiotic use in acute appendicitis.

Whether prophylactic antibiotics should be employed routinely in all patients with presumed appendicitis rather than be administered selectively to those with suspected perforation remains a controversial issue. The outcome of 312 adult patients undergoing appendectomy during periods of selective (I, n = 153) and routine (II, n = 159) antibiotic use were compared. Although the rates of misdiagnosis were comparable (9% vs 13%), significantly more patients with appendicitis in Period II had perforated appendicitis (29 of 139 vs 44 of 139, P less than 0.05). Prophylactic antibiotics were given to 43 (28%) patients in Period I compared to 132 (83%) in Period II (P less than 0.001). This, increased frequency was true for both simple (21% vs 81%, P less than 0.001) and perforated (66% vs 86%, P less than 0.05) appendicitis. A single antibiotic, most frequently a cephalosporin, was used significantly more often in Period II (44% vs 82%, P less than 0.001). There was no significant difference in the methods of wound closure between the two periods. The incidence of infectious complications was similar in patients with simple appendicitis in both periods (8% vs 11%), but it was significantly greater during Period I in patients with perforated appendicitis (45% vs 20%, P less than 0.05). The overall infection rate was similar in both periods (16% vs 22%). Thus, high-risk patients with perforated appendicitis were more likely to receive antibiotics and had a lower infection rate with routine antibiotic use. Furthermore, there was no overall change in the infection rate during this period, despite the use of less toxic, single drug regimens and a greater percentage of perforated appendicitis.

Acute Disease↗
PubMed2005

Validity of leukocyte count to predict the severity of acute appendicitis.

OBJECTIVE: To ascertain whether white blood cell (WBC) count with differential analysis may predict severity of disease in acute appendicitis. METHODS: We conducted this retrospective study on appendectomy patients from 1996 to 2001, at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. We reviewed patient's age, gender, duration of symptoms, temperature on admission, WBC count including differential and the histological diagnosis of the appendicular specimen. We further analyzed the data of those patients found to have acute, gangrenous and perforated appendicitis to determine the correlation between a high WBC count and a more advanced form of appendicitis. RESULTS: Out of an aggregate of 232 patients, 162 were males and 70 females with a mean age of 23.7 years (range, 12-70 years). Mean duration of symptoms was 1.9 +/- 1.1 days, mean temperature 37.8 +/- 1.4 degrees C, with reported elevated WBC count in 167 (71.9%) and normal in 65 (28.1%) cases. Mean WBC counts in acute were 14.5 +/- 7.3 x 10(9)/L, gangrenous 17.1 +/- 3.9 x 10(9)/L and perforated appendicitis 17.9 +/- 2.1 x 10(9)/L. This reflected a persistently higher WBC count in the complex (gangrenous, perforated) appendicitis compared with acute appendicitis (p < 0.05). The differential analysis showed neutrophilia in 123 (53%) and lymphopenia in 112 (48%) cases and out of these, 116 (94%) with neutrophilia and 107 (95%) with lymphopenia were reported to have appendicitis. CONCLUSION: A high WBC with differential count is a reliable indicator of the severity of appendicitis and signifies a more advanced stage.

Acute Disease↗
PubMed1991

[The diagnosis of appendicitis in childhood].

89 preschool children, 2-4 years old, treated under the diagnosis of appendicitis were analyzed. 46 of them were operated. In 39% of those children the diagnosis of an acute nonperforated appendicitis could have been ensured, in 39% the diagnosis of a perforated appendicitis was found, in 22% the was found, in 22% the laparotomy was negative. In cases of an acute perforated appendicitis typical symptoms were vomiting (100%), general stomach-ache (89%) and fever (61%). In most cases of an perforated appendicitis the state of patients was reduced drastically (80%), in 50% an ileus could be observed. Half a children with an acute nonperforated appendicitis as well as an perforated appendicitis had got a respiratory disease additionally. This fact was the main reason for the to late diagnosis particularly in the age up to 3. In all cases being not sure a consequent control at a ward is necessary; an important fact for this recommendation is the shortness of the acute perforated appendicitis in early childhood.

Appendicitis↗
PubMed2001

Detection of pinpoint tenderness on the appendix under ultrasonography is useful to confirm acute appendicitis.

HYPOTHESIS: Ultrasonography can be efficiently performed using new criteria for the diagnosis of acute appendicitis. DESIGN: Prospective trial. PATIENTS: Eighty-nine patients admitted to the hospital with suspected appendicitis between March 1998 and November 2000. INTERVENTION: At hospital admission, a staff surgeon evaluated each patient and determined whether the patient had appendicitis requiring immediate surgery or another disease. Patients then underwent ultrasonography. A sonographic transducer was placed on the area of maximal tenderness. When the pathological manifestation was depicted, the examiner slipped a fingertip between the transducer and the patient's skin and then pressed the area of depicted pathological manifestation to find pinpoint tenderness. When maximal pinpoint tenderness was noted on the appendix or on pathological manifestations contiguous to the appendix, we diagnosed the condition as appendicitis. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values, and overall accuracy. RESULTS: The diagnosis of appendicitis by this criteria had a sensitivity of 86.7%, a specificity of 89.7%, a positive predictive value of 94.5%, a negative predictive value of 76.5%, and overall accuracy of 87.6%. All 50 patients with pinpoint tenderness noted on the appendix had appendicitis. The surgeon's initial clinical impression had a sensitivity of 83.3%, a specificity of 44.8%, a positive predictive value of 75.8%, a negative predictive value of 56.5%, and overall accuracy of 70.8%. CONCLUSIONS: The efficacy of ultrasonography using the simple criteria was superior to that of the surgeon's initial clinical impression (P<.001). Our ultrasonographic criteria for the diagnosis of appendicitis are simple to use and efficient.

Acute Disease↗
PubMed2001

Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis.

HYPOTHESIS: The incidence of postoperative intra-abdominal abscess is higher after laparoscopic compared with open appendectomy for perforated appendicitis. METHODS: A historical cohort study of pediatric patients operated on for suspected appendicitis by open appendectomy or laparoscopic appendectomy compares the incidence of postoperative intra-abdominal abscess for each procedure. SETTING: A tertiary care center. PATIENTS: Five hundred thirty-eight pediatric patients were operated on for suspected appendicitis at our institution between 1974 and 1999. Of these, 453 were included in the study. Of the excluded patients, 9 had incomplete medical records, 69 had normal or interval appendectomies, and 7 had appendixes removed by methods other than laparoscopy or right lower quadrant incision. INTERVENTIONS: Open appendectomy performed through a right lower quadrant incision or laparoscopic appendectomy performed through a 3-trocar approach by 1 of 3 pediatric surgeons at our institution. MAIN OUTCOME MEASURE: The incidence of postoperative intra-abdominal abscess after laparoscopic vs open appendectomy. RESULTS: In perforated appendicitis (170 patients), the incidence of postoperative abscess after laparoscopic appendectomy was 24% vs 4.2% after open appendectomy. The relative risk ratio of developing a postoperative abscess after perforated appendicitis was 5.6 (confidence interval, 2.1-16.0) after laparoscopic vs open appendectomy. The results remained significant when controlled for age, sex, intraoperative irrigation, and preoperative antibiotics. Postoperative abscess in all acute, gangrenous, and perforated appendicitis after laparoscopic appendectomy was 6.4% vs 3.0% after open appendectomy. This was not statistically significant. CONCLUSION: There is a significant increase in the incidence of postoperative intra-abdominal abscess with perforated appendicitis after laparoscopic compared with open appendectomy in pediatric patients.

Abdominal Abscess↗
PubMed1981

Evolution of the age distribution and mortality of acute appendicitis.

Death due to appendicitis is still a significant occurrence. The stage when the disease is diagnosed and operation occurs has a decisive influence on the mortality. In our series of 9,652 cases of appendicitis, 26 patients died (0.27%)-ten (0.12%) of nonperforative appendicitis, and 16 (1.18%) of perforative appendicitis. Both the patients and the physician can delay treatment. The proportion of fatal cases is six times as great in perforative appendicitis is in those operated on in time. The deaths in those with a perforated appendix were usually caused by the basic disease or the surgical procedure, while in patients with unperforated appendixes, death was most commonly caused by other concomitant diseases. The proportion of the elderly in our series increased along with the rise in the average age of the population. The symptoms of acute appendicitis and the clinical findings are identical in the elderly and in the younger patients, but the disease in the aged advanced more rapidly to perforation and the mortality among them was higher. Active and careful attention to patients with possible diagnosis of appendicitis, especially in the elderly, is important.

Acute Disease↗
PubMed1993

Accuracy of ultrasound in the diagnosis of acute appendicitis compared with the surgeon's clinical impression.

OBJECTIVE: To compare the accuracy of the surgeon's clinical diagnosis of acute appendicitis with that of an ultrasonographic examination of the abdomen. DESIGN: Prospective trial. SETTING: US Navel Hospital, San Diego, Calif. PATIENTS: One hundred ten patients admitted to the hospital with suspected appendicitis from May 1990 to June 1992. INTERVENTION: Symptoms and signs for each patient were recorded, along with the surgeon's clinical impression of immediate surgery or observation. The patient then underwent an ultrasound examination performed by a staff radiologist. On the basis of the ultrasound findings the patient was placed into one of three categories: appendicitis, normal examination results, or other conditions. Patients with an ultrasound-based diagnosis of appendicitis proceeded to the operation, regardless of the surgeon's clinical impression. Those with other conditions diagnosed with ultrasonography were treated as was appropriate for the condition. RESULTS: The ultrasound-derived diagnosis of appendicitis had a sensitivity of 85.5%, a specificity of 84.4%, a positive predictive value of 88.3%, a negative predictive value of 80.1%, and an overall accuracy of 85.0%. The surgeon's clinical impression at the time of admission had a sensitivity of 62.9%, a specificity of 82.2%, a positive predictive value of 82.9%, a negative predictive value of 61.7%, and an overall accuracy of 71.2%. CONCLUSION: The overall accuracy of ultrasonography in the diagnosis of appendicitis was statistically superior to that of the surgeon's clinical impression (P < .0001). However, 24% of the patients with normal ultrasound findings were ultimately found to have appendicitis at operation, emphasizing the point that ultrasonography cannot be relied on to the exclusion of the surgeon's careful and repeated evaluation.

Acute Disease↗
PubMed1996

Laparoscopic appendectomy for complicated appendicitis.

BACKGROUND: Acute gangrenous and perforating appendicitis are associated with an increased risk for postoperative complications and have been considered a relative contraindication of laparoscopic appendectomy. OBJECTIVE: To determine the complication rate following laparoscopic appendectomy for gangrenous of perforating appendicitis. DESIGN: A retrospective analysis of patients who underwent laparoscopic appendectomy for gangrenous or perforating appendicitis. SETTING: A multispecialty clinic. RESULTS: Fifteen patients underwent laparoscopic appendectomy for gangrenous appendicitis and 19 patients for perforating appendicitis. In the gangrenous appendicitis group, average operating time was 85 minutes; average length of hospitalization, 2 days; and morbidity rate, 7% (one patient with abdominal abscess). The perforating appendicitis group had an average operating time of 84 minutes, hospitalization of 7 days, and a morbidity rate of 42%. This morbidity included five patients (26%) who developed intra-abdominal abscesses, two patients (10%) in whom wound infections developed, and one patient (5%) who died of Candida sepsis and multisystem organ failure.

Adolescent↗
PubMed2001

Has misdiagnosis of appendicitis decreased over time? A population-based analysis.

CONTEXT: Misdiagnosis of presumed appendicitis is an adverse outcome that leads to unnecessary surgery. Computed tomography, ultrasonography, and laparoscopy have been suggested for use in patients with equivocal signs of appendicitis to decrease unnecessary surgery. OBJECTIVE: To determine if frequency of misdiagnosis preceding appendectomy has decreased with increased availability of computed tomography, ultrasonography, and laparoscopy. DESIGN, SETTING, AND PATIENTS: Retrospective, population-based cohort study of data from a Washington State hospital discharge database for 85 790 residents assigned International Classification of Diseases, Ninth Revision procedure codes for appendectomy, and United States Census Bureau data for 1987-1998. MAIN OUTCOME MEASURE: Population-based age- and sex-standardized incidence of appendectomy with acute appendicitis (perforated or not) or with a normal appendix. RESULTS: Among 63 707 nonincidental appendectomy patients, 84.5% had appendicitis (25.8% with perforation) and 15.5% had no associated diagnosis of appendicitis. After adjusting for age and sex, the population-based incidence of unnecessary appendectomy and of appendicitis with perforation did not change significantly over time. Among women of reproductive age, the population-based incidence of misdiagnosis increased 1% per year (P =.005). The incidence of misdiagnosis increased 8% yearly in patients older than 65 years (P<.001) but did not change significantly in children younger than 5 years (P =.17). The proportion of patients undergoing laparoscopic appendectomy who were misdiagnosed was significantly higher than that of open appendectomy patients (19.6% vs 15.5%; P<.001). CONCLUSION: Contrary to expectation, the frequency of misdiagnosis leading to unnecessary appendectomy has not changed with the introduction of computed tomography, ultrasonography, and laparoscopy, nor has the frequency of perforation decreased. These data suggest that on a population level, diagnosis of appendicitis has not improved with the availability of advanced diagnostic testing.

Adolescent↗
PubMed2004

Surgical validation of unenhanced helical computed tomography in acute appendicitis.

BACKGROUND: Surgery for pain in the right lower quadrant of the abdomen remains a clinical dilemma. This prospective study assessed the accuracy of preoperative unenhanced helical computed tomography (CT) in the evaluation of patients with suspected acute appendicitis. METHODS: One hundred and three adult patients with suspected acute appendicitis underwent unenhanced helical CT of the abdomen. Subsequently, all patients underwent laparoscopic inspection of the abdominal cavity by a surgeon who was blinded to the diagnosis suggested by CT. Patients underwent appropriate surgical therapy accordingly. Follow-up was at least 6 weeks. RESULTS: Appendicitis was diagnosed by CT in 83 patients (80.6 per cent). Acute appendicitis was identified during laparoscopy in 87 patients (84.5 per cent). Prospective interpretation of CT images yielded a sensitivity of 95.4 per cent and a specificity of 100 per cent for the diagnosis of acute appendicitis. There were four false-negative scans. In 12 of 20 patients without signs of appendicitis on CT, the scan established the presence of other pathology. At operation no additional pathology was observed in this group and all other diagnoses proved to be correct. CONCLUSION: Plain helical CT in patients with suspected acute appendicitis provides an accurate diagnosis without the disadvantages of contrast enhancement.

Abdominal Pain↗
PubMed2005

MR imaging of the normal appendix and acute appendicitis.

PURPOSE: To describe the MR appearance of the normal appendix and the MR imaging characteristics of acute appendicitis with correlation to pathological severity. MATERIALS AND METHODS: A total of 20 volunteers participated in this study to demonstrate normal appendices by MR imaging. A total of 37 consecutive patients with clinically diagnosed acute appendicitis were also scanned. T1-weighted (T1WI) spin-echo images, T2-weighted (T2WI) fast spin-echo, and fat-suppressed spectral presaturation inversion recovery T2-weighted (T2SPIR) fast spin-echo images were obtained. The MR criteria for considering acute appendicitis were as follows: 1) thickening of the appendiceal wall with high intensity on T2WI or T2SPIR; 2) dilated lumen filled with high intensity material on T2WI or T2SPIR; and 3) increased intensity of periappendiceal tissue on T2WI or T2SPIR. RESULTS: The visibility of a normal appendix on MR imaging was 90% (18/20). It appeared as a cord-like structure of medium intensity without fluid collection in the lumen. A total of 30 cases with clinically diagnosed acute appendicitis had positive MR findings and all except one were pathologically proven. The one had cecal diverticulitis. These cases demonstrated filled lumen, with a hypointense wall on T1WI and slightly hyperintense on T2WI or T2SPIR. MR findings correlated well with pathological severity, especially a thicker wall, periappendiceal high intensity, and ascites were useful for suspecting severe appendicitis. CONCLUSION: Correct diagnosis of acute appendicitis was obtained with MRI, and correlated well with its pathological severity. MRI is a powerful alternative for diagnosing acute appendicitis especially for the patients in whom the radiation is major concern.

Acute Disease↗