"The decision to forego surgery in these patients often results in missed appendicitis, with a possible increased risk of perforation," said study co-author Emily M. Webb, M.D., assistant professor of clinical radiology at the University of California, San Francisco.
Acute appendicitis, which occurs when the appendix — a small, tube-like structure attached to the large intestine — becomes blocked and inflamed, requires prompt surgical removal. Left untreated, an inflamed appendix will eventually perforate, or burst, spilling infectious materials into the abdominal cavity, which can be life-threatening. In the less common chronic and recurrent appendicitis, patients experience milder symptoms that may come and go. According to the National Institutes of Health, appendicitis can affect anyone, but is more common among people 10 to 30 years old. Appendicitis leads to more emergency abdominal surgeries than any other cause.
For the study, the researchers reviewed CT reports and medical records of 2,283 patients who underwent CT for suspected appendicitis at the University of California, San Francisco Medical Center between 2002 and 2007. Patients in the study included 856 men and 1,427 women between the ages of 18 and 99 years old with a mean age of 46.
"We wanted to look at patients with a positive CT scan but atypical clinical symptoms who did not have their appendix immediately removed," Dr. Webb said.
Of the study's 2,283 patients, 516, or 23 percent, had CT findings that indicated a probable or definite appendicitis. Of those 516 patients, 450 (87 percent) had their appendix surgically removed within four days. Ninety-five percent of those cases were confirmed as acute appendicitis.
Forty-nine (10%) of 516 patients had nonsurgical treatment, including antibiotics or percutaneous abscess drainage. An additional four of 516 patients were lost to follow up.
Thirteen (three percent) of the 516 patients with positive CT findings did not receive immediate surgical treatment because their symptoms — including a normal appetite, absence of nausea and vomiting, normal white blood cell count and mild or resolving pain — were atypical for acute appendicitis. Of those, five (38 percent) ultimately had their appendix removed after seeking treatment for the same symptoms an average of four months later. Appendicitis was confirmed in all cases.
"The results of our study confirm that CT is a good diagnostic tool for appendicitis and that surgeons should be wary of dismissing positive CT findings," Dr. Webb said. "Prompt treatment of chronic or recurrent appendicitis can prevent patients from developing complications or other future ill effects."
The study's findings may also help explain the disparity between CT results that indicate appendicitis and patient symptoms that do not.
"When the appendix is not completely obstructed, it can result in a milder form of appendicitis that is chronic or recurring," Dr. Webb said. "But the three forms of appendicitis, acute, chronic and recurrent, are indistinguishable on CT scans.
"Acute Appendicitis: Clinical Outcome in Patients with an Initial False-Positive CT Diagnosis." Collaborating with Dr. Webb were Joseph W. Stengel, D.O., Liina Poder, M.D., Benjamin M. Yeh, M.D., Rebecca Smith-Bindman, M.D., and Fergus V. Coakley, M.D.
Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (http://radiology.RSNA.org/)
RSNA is an association of more than 44,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (RSNA.org)
Smart Data Transformation – Surfing the Big Wave
02.12.2016 | Fraunhofer-Institut für Angewandte Informationstechnik FIT
Climate change could outpace EPA Lake Champlain protections
18.11.2016 | University of Vermont
In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.
Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...
Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
08.12.2016 | Life Sciences
08.12.2016 | Physics and Astronomy
08.12.2016 | Materials Sciences