Therapeutic Impact of Computerized Tomography Scan in Acute Appendicitis
Journal Title: International Journal Of Research In Medicine - Year 2016, Vol 5, Issue 4
Abstract
BACKGROUND: The diagnosis of acute appendicitis is essentially clinical however operating based on clinical suspicion alone can lead to removal of normal appendix in 15 - 30% of cases. A number of clinical and laboratory based scoring systems have been changed to assist diagnosis. In 90% cases of appendicitis WBC Count is greater than 10,000/mm3 with neutrophil predominance (Bower et al1). Blood and pus cells in the urine routine examination may be due to approximation of inflamed appendix to the ureter(Graham2). X-ray study is of some help in establishing the diagnosis (Thornbury J.R & Eugene D.C3). Barium enema4-6 has been historically used to diagnose appendicitis, Ultrasound and can be done in all set-ups and can be used in all age groups and in pregnancy(Jeffery7). It is found to diagnose inflammatory appendix with a specificity of 90-99% and sensitivity of 75-90%. Graded compression markedly increases the diagnostic accuracy(Puylaert8). Contrast enhanced (CT Scan) is most useful when there is diagnostic uncertainty particularly older patients in whom acute diverticulitis, intestinal obstruction, or neoplasm are likely differentials . It has the following diagnostic accuracy: 92-97% sensitivity, 85-94% specificity, 90-98% accuracy, and 75-95% positive and 95-99% negative predictive values9-11. OBJECTIVES: 1) To study the change in the therapeutic approach and outcome of patients who are subjected to Computerised Tomography Scan. 2)To study the efficacy of CT Scan in diagnosis of acute appendicitis in comparison to ultrasound. CONCLUSIONS: 1) CT of the appendix had an important therapeutic impact on patients presenting to SSG hospital’s emergency department in that it resulted in a change in management plan in 26 of 57 patients (50%). 2) CT need not be done in patients in whom the likelihood of appendicitis is clinically unlikely but CT findings are often of benefit even when appendicitis is judged to be very likely. 3) The use of HRCT in patients with equivocal clinical presentations suspected to have acute appendicitis leads to a markedt improvement in the preoperative diagnosis and to a lower negative appendectomy rate. 4) Helical CT has been shown to be a great imaging tool for differentiating appendicitis from most acute gynecological and geriatric acute abdominal conditions. 5) When the appendix measures less than 6 mm alone, the likelihood of appendicitis is very less. 6) Appendiceal CT is an accurate, reliable and a safe technique to diagnose or to exclude acute appendicitis. It can improve medical care and reduce the overall costs for patients suspected of having acute appendicitis. 7) Increasing the use of CT scanning, being aware of its potential hazards and understanding the subtleties of interpretation can further improve diagnostic accuracy.
Authors and Affiliations
Vivek Viswanthan, Nimish J. Shah, Nupur Shah
Keywords
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