Computed tomography in differential diagnosis of abdominal pain among patients with suspected acute appendicitis

Objectives : Acute appendicitis is mostly diagnosed in clinic evaluation and with ultrasonography (USG). Computed tomography (CT) is often preferred as an advanced imaging to clarify the causes of abdominal pain. In this study, the diagnostic effectiveness of CT in cases of suspected acute appendicitis was investigated. Methods: The data from the adult patients who had applied to the emergency department with abdominal pain, undergone USG and CT imaging with suspected acute appendicitis and operated with that reason were scanned retrospectively. The demographic characteristics, imaging results and post-operative pathology results of the patients were recorded. Results: It was found that 289 (28%) of the 1030 cases having suspected acute appendicitis had undergone CT imaging. The median age of the patients was 33 years ( IQR: 24-43) and 54% of those were male. The pathology reports were accepted to be golden standard for the diagnosis of acute appendicitis. According to the results obtained, CT imaging was found to be effective even in suspected cases (p<0.01). In the ROC analysis, the AUC value was 0.652 (95% CI: 0.546-0.727). In 28 cases (9%) for which the diagnosis of acute appendicitis was not verified in the post-operative pathology reports, lymphatic adenitis (n:16), malignity (n:6), normal findings (n:3), acute pelvic inflammatory disease (n:2) and diverticulitis (n:1) were detected. Of those patients, 22 (78%) were females. Conclusion: Computed tomography is an effective method of imaging in differential diagnosis of patients who apply to the emergency department with abdominal pain and who have suspected acute appendicitis.  Especially in female patients, additional serious diagnoses other than acute appendicitis can also be detected.