ROLE OF COMPUTED TOMOGRAPHY IN SUSPECTED ACUTE APPENDICITIS : A STUDY

BACKGROUND: Acute abdomen is one of the most common referral to the emergency radiologist is. In practice acute appendicitis is the most common diagnosis. Acute appendicitis is often considered as a clinical diagnosis and imaging is an adjuvant to it. With the increase in awareness among the layman present day practice it is difficult to convince the patient to undergo surgery when the ultrasound shows non visualization of the appendix. In view of the above, we decided to study the role of Computed Tomography in diagnosing appendix is not detected by ultrasound. AIMS: The role of Computed Tomography in diagnosing acute appendicitis when ultrasound cannot visualize the appendix. METHODS AND MATERIALS: This was a prospective study done from January 2008 to December 2013 on patients who presented with acute abdomen and had a strong clinical suspicion of appendicitis but on ultrasound appendix could not be visualized. After excluding patients who were managed conservatively and not willing for Computed Tomography the patients were subjected to Computed Tomography and the data was analyzed by percentage frequency. RESULTS: During the period 78 patients which were normal on ultrasound and had a strong clinical suspicion of appendicitis and who refused surgery without further imaging confirmations were included in the study.6 patients who had normal imaging on CT refused surgery and were managed conservatively. They continued to have symptoms of right iliac fossa discomfort. In the rest 72 patients who underwent CT, 35 patients had evidence of an appendicolith were subjective to surgery there was histological confirmation of appendicitis in 34; 1 had evidence of sub-acute appendicitis, rest of the of the 35 patients whom CT showed no signs of appendicitis; intra-operatively 16 had sand like granular sand like material in the appendiceal lumen and 2 were normal, but histopathological examination showed lymphoid hyperplasia suggesting a chronic insult. All the 72 patients were followed up and were symptom free. CONCLUSION: Whenever there is a strong clinical evidence of appendicitis and ultrasound does not pick up any pathology it’s worthwhile to consider a Computed Tomography to diagnose the cause of acute abdomen so that negative appendectomy rate can be reduced.