Imaging as an aid to the diagnosis of acute appendicitis

  • Wijesuriya Lionel I
Keywords: Appendicitis, diagnosis, computed tomography, ultrasound

Abstract

Acute appendicitis has been known as a disease entity for well over a century but a confident diagnosis before surgeryin all patients suspected of the condition is still not possible. Timely diagnosis is essential to minimise morbidity due topossible perforation of the inflamed organ in the event treatment is delayed; so much so that surgeons often preferredto operate at the slightest suspicion of the diagnosis in the past. This resulted in the removal of many normal appendixes.When the diagnosis of appendicitis is clear from the history and clinical examination, then no further investigation isnecessary and prompt surgical treatment is appropriate. Where there is doubt about the diagnosis however it is advisableto resort to imaging studies such as abdominal ultrasound or computed tomography to clear such suspicions beforesubjecting the patient to an appendicectomy. These studies would also help avoid delays in surgery in deserving patients.

References

Fitz RH. Perforating inflammation of the vermiform appendix: With special reference to its early diagnosis and treatment. Trans Assoc Am Physicians. 1886;1:107-144.

Körner H, Söndenaa K, Söreide JA, et al. Incidence of acute nonperforated and perforated appendicitis: age-specific and sexspecific analysis. World J Surg. 1997;21(3):313-7.

Blab E, Kohlhuber U, Tillawi S et al. Advancements in the diagnosis of acute appendicitis in children and adolescents. Eur J Pediatr Surg. 2004;14(6):404-9.

Guttman R, Goldman RD, Koren G. Appendicitis during pregnancy. Can Fam Physcian. 2004;50:355-7.

Liu CD, McFadden DW. Acute abdomen and appendix. In: Greenfield LJ, Mulholland MW, Oldham KT, et al., editors. Surgery: Scientific Principles and Practice. 2nd edition. Philadelphia: Lippincott, Williams & Wilkins; 1997. p. 1246-61.

Allen JG, Harkins HN, Moyer CA, Rhoads JE. Surgery principles and practice. Philadelphia: Lippincott; 1957. p. 1495.

Deutsch AA, Shani N, Reiss R. Are some appendectomies unnecessary? An analysis of 319 white appendices. J R Coll Surg Edinb. 1983;28(1):35-40.

Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology. 2000;215(2):337-48.

Chua MW, Fazidah Y, Khalijah MY, et al. A review of acute appendicitis seen in the Taiping District Hospital from July to December, 1990. Med J Malaysia .1993;48(1):28-32.

Lee HY, Jayalakshmi P, Noori SH. Acute appendicitis – the University Hospital experience. Med J Malaysia. 1993;48(1):17-27.

Thanaletchimy N. Acute appendicitis: pathology of 1000 cases. Med J Malaysia 1986;41(4):336-42.

Lee CM, Teoh MK. Perforated appendicitis - the Malaysian Experience. J R Coll Surg Edinb. 1990;35(2):83-7.

Murphy JB. Two thousand operations for appendicitis, with deductions from personal experience. Am J Med Sci. 1904;128:187-211.

Rosengren D, Brown AF, Chu K. Radiological imaging to improve the emergency department diagnosis of acute appendicitis. Emerg Med Australas. 2004;16(5-6):410-6.

Karpelowsky JS, Bickler S, Rode H. Appendicitis – pitfalls and medicolegal implications. S Afr Med J. 2006;96(9 Pt 2):866-72.

Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91(1):28-37.

McBurney C. Experiences with early operative interference in cases of disease of the vermiform appendix. NY Med J. 1889;50:676-84.

Hardin DM Jr. Acute appendicitis: review and update. Am Fam Physician. 1999;60(7):2027-34.

Calder JD, Gajraj H. Recent advances in the diagnosis and treatment of acute appendicitis. Br J Hosp Med .1995;54(4):129-33.

Coleman C, Thompson JE Jr, Bennion RS, et al. White blood cell count is a poor predictor of severity of disease in the diagnosis of appendicitis. Am Surg 1998(10);64:983-5.

Old JL, Dusing RW, Yap W, et al. Imaging for suspected appendicitis. Am Fam Physician. 2005;71(1):71-8.

Blebea JS, Meilstrup JW, Wise SW. Appendiceal imaging: which test is best? Semin Ultrasound CT MR. 2003;24(2):91-5.

Way LW. Appendix. In: Way LW, Doherty GM, editors. Current Surgical Diagnosis and Treatment. 12th Edition. New York: Lange Medical Books/ McGraw-Hill; 2006. p. 649.

Rao PM, Rhea JT, Rao JA, et al. Plain abdominal radiography in clinically suspected appendicitis: diagnostic yield, resource use, and comparison with CT. Am J Emerg Med. 1999;17(4):325-8.

Graffeo CS, Counselman FL. Appendicitis. Emerg Med Clin North Am. 1996;14(4):653-71.

Hoffmann J, Rasmussen OO. Aids in the diagnosis of acute appendicitis. Br J Surg. 1989;76(8):774-9.

Zielke A, Hasse C, Sitter H et al. Influence of ultrasound on clinical decision making in acute appendicitis: A prospective study. Eur J Surg. 1998;164(3):201-9.

Franke C, Böhner H, Yang Q, et al. Ultrasonography for diagnosis of acute appendicitis: Results of a prospective multicenter trial. Acute Abdominal Pain Study Group. World J Surg. 1999;23(2):141-6.

Kaiser S, Frenckner B, Jorulf HK. Suspected appendicitis in children: US and CT - A prospective randomized study. Radiology. 2002;223(3):633-8.

Raman SS, Lu DS, Kadell BM, et al. Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: A 5-year review. AJR Am J Roentgenol. 2002;178(6):1319-25.

Rao PM, Rhea JT, Novelline RA, et al. Effect of computed tomography of the appendix on the treatment of patients and the use of hospital resources. N Engl J Med. 1998;388(3):141-6.

Fuchs JR, Schlamberg JS, Shortsleeve MJ, et al. Impact of abdominal CT imaging on the management of appendicitis: an update. J Surg Res. 2002;106(1):131-6.

Terasawa T, Blackmore CC, Bent S, et al. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Int Med. 2004(7);141:537-46.

Published
2007-12-31
How to Cite
Lionel IW. (2007). Imaging as an aid to the diagnosis of acute appendicitis. Malaysian Family Physician, 2(3), 4. Retrieved from https://www.e-mfp.org/ojs3/index.php/MFP/article/view/262
Section
Original Articles