Outcomes in 74 patients with an appendicolith who did not undergo surgery: is follow-up imaging necessary?

Area of Science:

• Radiology
• Gastroenterology
• Surgical Outcomes

Background:

• Appendicoliths are frequently identified on abdominal computed tomography (CT) scans.
• The clinical significance of incidentally discovered appendicoliths without acute appendicitis symptoms is not fully established.
• Management decisions for patients with appendicoliths often involve balancing the risk of future appendicitis against the morbidity of surgery.

Purpose of the Study:

• To evaluate the clinical outcomes of patients diagnosed with an appendicolith on CT who initially did not undergo appendectomy.
• To determine the rate of subsequent appendicitis in patients with appendicoliths managed non-operatively.
• To assess whether an appendicolith is an absolute indication for appendectomy.

Main Methods:

• Retrospective review of 45,901 abdominal CT examinations (March 2000-March 2004) for reports mentioning "appendicolith" or "fecalith".
• Identification of patients with appendicoliths who were discharged without immediate appendectomy.
• Clinical follow-up of 74 such patients to assess for re-presentation with symptoms requiring appendectomy.

Main Results:

• Of 74 patients with appendicoliths not undergoing initial surgery, 52 (70%) had no appendiceal symptoms and did not return with appendicitis.
• Twenty-two patients (30%) had possible appendiceal symptoms; 5 of these (23%) later presented with pathologically proven acute appendicitis.
• All patients who returned with appendicitis had exhibited possible appendiceal symptoms at their initial presentation.

Conclusions:

• An appendicolith identified on CT may serve as a marker for an increased risk of developing appendicitis.
• However, the presence of an appendicolith alone is not a sufficient indication for immediate appendectomy.
• Conservative management may be appropriate for patients with appendicoliths, particularly those without acute symptoms.