Prediagnostic Clinical Evaluations and Double Contrast Computed Tomography in Suspected Acute Appendicitis

Abstract

Objectives: The aim of this study is to reveal the diagnostic value of abdominal computed tomography (CT) in patients with suspected acute appendicitis according to their histopathological diagnosis and who were operated on after double contrast abdominal CT. Methods: The data of patients who were admitted to Bakirkoy Dr. Sadi Konuk Research and Training Hospital Emergency Medicine Clinic between March 01, 2009, and March 01, 2011, due to abdominal pain and were operated on with a clinical diagnosis of the acute appendicitis have been reviewed. The case group consisted of 111 patients who underwent preoperative double-contrast abdominal CT scans; the control group consisted of 50 randomly selected patients who were operated on without abdominal CT scans. Results: In this study, 57.1% of patients were male, 42.9% of patients were female, and the mean age of patients was 38.90±16.38 years. There was no significant difference between the groups in terms of gender, age, symptoms, body temperature, abdominal physical examination, white blood cells, complete urinalysis results, or Alvarado score (p>0.05). The diagnostic difference between ultrasonography (USG) and CT was found to be statistically significant in patients who were histopathologically diagnosed with appendicitis compared to those who did not. While the sensitivity of USG was 35.71%, specificity 85.71%, positive predictive value (PPV) 90%, and negative predictive value (NPV) 27.02%, the sensitivity of CT was 60.46%, specificity 92%, PPV 92.85%, and NPV 40.35% was found in the diagnosis of acute appendicitis. Conclusion: CT is one of the essential methods that can be used in the diagnosis of acute appendicitis in the emergency department and it can reduce unnecessary laparotomies. Acute appendicitis can be diagnosed by clinical examination and USG in the emergency department, but the value of CT was higher in patients who could not be diagnosed with acute appendicitis by USG.