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Comparative study of imaging features in uncomplicated and complicated acute appendicitis
Osman Şimşek1, Sabri Şirolu2, Yağmur Özkan Irmak3
1Department of Genaral Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul-Türkiye.
Summary
Imaging findings like increased appendiceal diameter, periappendiceal air, effusion, and appendicolith help differentiate uncomplicated appendicitis from complicated forms. These CT scan indicators are vital for accurate diagnosis and treatment planning.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Pathology
Background:
- Acute appendicitis is a frequent cause of acute abdominal pain requiring surgery.
- Distinguishing between uncomplicated and complicated appendicitis is essential for treatment decisions.
- Computed tomography (CT) plays a key role in diagnosing appendicitis and its subtypes.
Purpose of the Study:
- To identify and evaluate distinct imaging findings on CT scans for uncomplicated appendicitis and its complicated forms (phlegmonous, gangrenous, perforated).
- To aid in the differential diagnosis of appendicitis subtypes based on imaging characteristics.
- To correlate imaging findings with pathological outcomes.
Main Methods:
- Retrospective analysis of 1,094 patient CT scans (January 2014 - December 2023) with confirmed appendicitis pathology.
- Evaluation of appendiceal diameter, wall thickness, fat stranding, effusion, lymphadenopathy, intraluminal/free air, mucosal enhancement, and appendicolith presence.
- Comparison of imaging features across uncomplicated, phlegmonous, gangrenous, and perforated appendicitis groups.
Main Results:
- Perforated appendicitis showed significantly larger appendiceal diameter, more periappendiceal air, effusion, and intraluminal appendicolith (p<0.05).
- Appendiceal wall thickness was greater in perforated and lesser in non-perforated gangrenous appendicitis compared to uncomplicated cases (p<0.05).
- Intraluminal air, in conjunction with other findings, specifically predicted complicated appendicitis.
Conclusions:
- Appendiceal diameter, periappendiceal air, effusion, and intraluminal appendicolith are critical CT imaging differentiators for appendicitis subtypes.
- These imaging parameters provide valuable insights for accurate clinical diagnosis and management of acute appendicitis.
- Further prospective studies and advanced imaging are recommended to validate findings and improve diagnostic accuracy.
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