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Related Concept Videos

Appendicitis-I: Introduction01:22

Appendicitis-I: Introduction

The appendix, a small, narrow, blind tube extending from the inferior part of the cecum, is widely regarded as a vestigial organ, having lost much of its original function through evolution. Despite its diminished role, the appendix can become inflamed, a condition known as appendicitis.
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
Appendicitis01:19

Appendicitis

Appendicitis is an acute inflammatory condition of the vermiform appendix, most commonly caused by obstruction of its lumen. The appendix is a narrow, blind-ended pouch that extends from the cecum, making it particularly prone to obstruction. Causes include fecaliths, lymphoid hyperplasia (often after viral infections), parasites, tumors, or foreign bodies. This obstruction initiates a cascade of pathological changes.Luminal Obstruction and Early InflammationAfter obstruction, normal mucosal...
Appendicitis-II: Diagnostic Studies and Management01:29

Appendicitis-II: Diagnostic Studies and Management

Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
Computed Tomography01:10

Computed Tomography

Tomography refers to imaging by sections. Computed tomography (CT) is a non-invasive imaging technique that uses computers to analyze several cross-sectional X-rays to reveal minute details about structures in the body.
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
Assessment of the Abdomen II: Percussion01:18

Assessment of the Abdomen II: Percussion

Percussion is a fundamental technique used to assess the liver, spleen, and abdominal organs by tapping the abdomen and interpreting the resulting sounds. This method helps identify fluid, distention, and masses through variations in sound, such as the high-pitched tympany of air-filled areas and the dullness of solid masses. Understanding how to percuss these organs provides valuable information for healthcare professionals in diagnosing conditions early.
Percussion
Percussion is an essential...
Imaging Studies III: Computed Tomography01:27

Imaging Studies III: Computed Tomography

DefinitionComputed Tomography (CT) of the genitourinary (GU) tract is a non-invasive imaging modality that utilizes X-rays and computer processing to generate detailed cross-sectional images of the urinary system, encompassing the kidneys, ureters, bladder, and adjacent structures such as the adrenal glands.PurposeCT scans of the GU tract serve several diagnostic and therapeutic purposes, including:Diagnosis of Urinary Tract Diseases: Detects kidney stones, tumors, cysts, and congenital...

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An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta
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Accuracy of computed tomography in predicting appendiceal perforation.

Jason D Fraser1, Pablo Aguayo, Susan W Sharp

  • 1Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.

Journal of Pediatric Surgery
|January 29, 2010
PubMed
Summary

Computed tomography (CT) scans for diagnosing perforated appendicitis in children without abscesses are not always accurate. This imaging may lead to unnecessary prolonged treatment for some patients.

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Area of Science:

  • Radiology
  • Pediatric Surgery
  • Gastroenterology

Background:

  • Nonoperative management of perforated appendicitis relies on accurate computed tomography (CT) diagnosis.
  • An institutional definition of perforation (hole or fecalith) aids in risk stratification for abscess.
  • The diagnostic accuracy of CT for these perforation criteria requires quantification.

Purpose of the Study:

  • To evaluate the accuracy of computed tomography (CT) in identifying appendiceal perforation based on specific institutional criteria.
  • To assess the performance of surgeons and radiologists in interpreting CT scans for perforated appendicitis.

Main Methods:

  • Review of 200 pediatric CT scans by 6 surgeons and 2 radiologists, blinded to clinical outcomes.
  • Scans were evaluated for perforated versus nonperforated appendicitis using an intraoperative definition.
  • Exclusion of cases with a well-formed abscess on CT.

Main Results:

  • Overall diagnostic accuracy was 72%, with sensitivity of 62% and specificity of 81%.
  • Positive predictive value was 67%, and negative predictive value was 77%.
  • Performance varied among reviewers with different experience levels.

Conclusions:

  • CT interpretation for appendiceal perforation, in the absence of a well-formed abscess, has limitations.
  • Relying solely on preoperative CT diagnosis for triage may be imprudent.
  • This can potentially lead to prolonged and unnecessary treatment courses for pediatric patients.