Appendicitis with perforation: the dilated transverse colon sign.

Area of Science:

• Radiology
• Gastroenterology
• Surgical Pathology

Background:

• Acute appendicitis is a common surgical emergency.
• Early diagnosis of appendicitis, particularly perforation, is crucial for patient outcomes.
• Radiographic assessment plays a role in diagnosing appendicitis.

Purpose of the Study:

• To describe a previously unrecognized radiographic sign in acute appendicitis.
• To evaluate the association of this sign with appendiceal perforation.
• To determine the potential utility of this sign in plain film assessments.

Main Methods:

• Retrospective review of plain film radiographs from 82 patients diagnosed with acute appendicitis.
• Identification and documentation of the "dilated transverse colon sign" in the study cohort.
• Correlation of the sign's presence with the occurrence of appendiceal perforation.

Main Results:

• The "dilated transverse colon sign" was observed in 10 out of 82 patients (12.2%) with acute appendicitis.
• Appendiceal perforation was confirmed in all 10 patients exhibiting this sign.
• The sign was absent in patients with non-perforated appendicitis.

Conclusions:

• The "dilated transverse colon sign" appears to be a specific radiographic indicator of appendiceal perforation.
• This sign may represent one of the earliest radiographic findings of perforation in acute appendicitis.
• The sign's likely etiology involves paralytic ileus of the transverse colon and ascending colon spasm, making it a valuable diagnostic aid.