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Appendicitis-II: Diagnostic Studies and Management01:29

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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:
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Appendicitis-I: Introduction01:22

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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.
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Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
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Radiological investigations, including X-rays and computed tomography (CT) scans, are critical for diagnosing and evaluating various medical conditions. These imaging techniques provide valuable insights into the body's internal structures, aiding in the detection of abnormalities, assessment of disease progression, and development of treatment strategies. This article delves into two primary radiological investigations, chest X-rays and CT scans, outlining their purpose, procedures, and...
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CT scans do not reliably identify appendicoliths in acute appendicitis.

J G Mariadason1, P Bhattarai2, S Shah2

  • 1Chief of Sub-Division of General Surgery, Metropolitan Hospital Center, Associate Professor of Surgery, New York Medical College at Metropolitan Hospital, 12th Floor, Metropolitan Hospital, 1901 First Ave, New York, NY, 10029, United States.

Surgery in Practice and Science
|January 23, 2025
PubMed
Summary

Computed tomography (CT) scans are unreliable for detecting appendicoliths, which can impact nonoperative management of appendicitis. This study found low accuracy in CT scans identifying appendicoliths, suggesting shared decision-making for treatment.

Keywords:
AppendicolithCT scanNOMANPVPPVReliability

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Area of Science:

  • Radiology
  • Gastroenterology
  • Surgical Innovation

Background:

  • Nonoperative management of appendicitis (NOMA) is effective for uncomplicated cases.
  • Appendicoliths are associated with increased complication risk, making them a relative contraindication to NOMA.
  • The accuracy of computed tomography (CT) in identifying appendicoliths is often assumed but not well-established.

Purpose of the Study:

  • To evaluate the accuracy of CT scans in identifying appendicoliths.
  • To compare CT findings with pathological specimens.
  • To inform clinical decision-making regarding NOMA.

Main Methods:

  • Retrospective electronic medical record review of 1552 appendectomy patients with pre-operative CT scans (2001-2019).
  • Two radiologists reinterpreted CT scans for appendicolith presence.
  • Comparison of CT findings with appendicoliths identified in surgical pathology specimens.
  • Calculation of positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity.

Main Results:

  • Overall PPV for appendicoliths on CT was 62% (Cohort A: 69%, Cohort B: 57%).
  • Overall NPV was 83% (Cohort A: 80%, Cohort B: 87%).
  • Overall sensitivity was 55% (Cohort A: 48%, Cohort B: 66%), with specificity at 86% (Cohort A: 91%, Cohort B: 82%).
  • Significant variation in radiologist accuracy was observed.

Conclusions:

  • CT identification of appendicoliths is not reliable, challenging its use as a sole determinant for NOMA.
  • The presence of appendicoliths on CT should not exclude patients from antibiotic treatment.
  • CT findings of appendicoliths should be part of a shared decision-making process for appendicitis management.