Patients Without Typical Appendicitis Signs but Positive CT May Still Need Surgery
Last Updated: 2010-05-27 16:21:09 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Don't see typical clinical signs of appendicitis? Better check that computerized tomography (CT) scan before sending your patient home, according to a new study.
"CT is so good at making this diagnosis (of appendicitis) that if the appendix looks abnormal at CT, surgeons should really consider doing an appendectomy even if the clinical symptoms seem atypical," said Dr. Emily Webb, a study co-author and radiologist at the University of California, San Francisco (UCSF).
Dr. Webb and her colleagues retrospectively reviewed CTs and medical reports of 2,283 patients at the UCSF Medical Center who had undergone the test because of suspected appendicitis.
Of these, 516 patients had scans suggesting probable or definite appendicitis. Most of those were treated surgically, but 13 of those patients received no immediate treatment because they did not have typical symptoms of appendicitis.
Medical records showed that five of the initially untreated patients ended up with a diagnosis of appendicitis and underwent surgery. Three of those were operated on within 17 days, but one didn't go to the operating room until almost 15 months later.
Three of those who had surgery had perforated appendices by the time of the operation.
Of the other eight patients, one had a normal appendix at surgery, and seven were never diagnosed with appendicitis.
Patients without clinical symptoms had either been referred to gastroenterologists or discharged after their symptoms abated, often without specific follow-up plans, said Dr. Joseph Stengel, lead author and a radiologist at Gray's Harbor Imaging in Aberdeen, Washington.
The results, say Dr. Stengel, "point out that there is a spectrum of appendicitis, and CT is probably more sensitive to early or chronic or other forms of appendicitis that might be lower on the spectrum, and that those patients certainly shouldn't be dismissed without follow-up."
Bottom line, Dr. Webb said: "If that appendix looks abnormal at CT, it looks abnormal for a reason."
http://radiology.rsna.org/content/early/2010/05/17/radiol.10091229.abstract
Radiology 2010.
Copyright © 2010 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
