"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)
New study from the University of Halle: How climate change alters plant growth
12.01.2018 | Martin-Luther-Universität Halle-Wittenberg
Disarray in the brain
18.12.2017 | Universität zu Lübeck
Physicists have developed a technique based on optical microscopy that can be used to create images of atoms on the nanoscale. In particular, the new method allows the imaging of quantum dots in a semiconductor chip. Together with colleagues from the University of Bochum, scientists from the University of Basel’s Department of Physics and the Swiss Nanoscience Institute reported the findings in the journal Nature Photonics.
Microscopes allow us to see structures that are otherwise invisible to the human eye. However, conventional optical microscopes cannot be used to image...
On the way to an intelligent laboratory, physicists from Innsbruck and Vienna present an artificial agent that autonomously designs quantum experiments. In initial experiments, the system has independently (re)discovered experimental techniques that are nowadays standard in modern quantum optical laboratories. This shows how machines could play a more creative role in research in the future.
We carry smartphones in our pockets, the streets are dotted with semi-autonomous cars, but in the research laboratory experiments are still being designed by...
What enables electrons to be transferred swiftly, for example during photosynthesis? An interdisciplinary team of researchers has worked out the details of how...
For the first time, scientists have precisely measured the effective electrical charge of a single molecule in solution. This fundamental insight of an SNSF Professor could also pave the way for future medical diagnostics.
Electrical charge is one of the key properties that allows molecules to interact. Life itself depends on this phenomenon: many biological processes involve...
At the JEC World Composite Show in Paris in March 2018, the Fraunhofer Institute for Laser Technology ILT will be focusing on the latest trends and innovations in laser machining of composites. Among other things, researchers at the booth shared with the Aachen Center for Integrative Lightweight Production (AZL) will demonstrate how lasers can be used for joining, structuring, cutting and drilling composite materials.
No other industry has attracted as much public attention to composite materials as the automotive industry, which along with the aerospace industry is a driver...
08.01.2018 | Event News
11.12.2017 | Event News
08.12.2017 | Event News
23.01.2018 | Life Sciences
23.01.2018 | Earth Sciences
23.01.2018 | Physics and Astronomy