Imaging Technique Assistance Or Time Saving Strategy In Acute Appendicitis Management?

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Graded compression sonography and computed tomography (CT) have been used over the last 2 decades as adjuncts to the clinical assessment of patients with possible appendicitis.

Although sonography lacks ionizing radiation and costs less than CT does, it is limited by its inability to dependably visualize the normal appendix and, therefore, its inability to reliably exclude appendicitis when this disorder is absent. Sonographic visualization rates for the appendix vary from as low as 2.4% to greater than 70%.

Eric W. Olcott and coauthors from Department of Radiology, Stanford University School of Medicine had  demonstrated that most short-interval CT scans in this clinical setting reveal normal findings, and relatively few disclose appendicitis or disorders that require urgent surgery.

From other hand the reliance on clinical examination with complimentary use of laboratory tests is a time-honored means of diagnosing acute appendicitis. Traditionally, surgeons have operated with a degree of uncertainty, tolerating a number of non-therapeutic appendectomies because of the increased morbidity and mortality associated with delay in diagnosis and consequent perforation. Lower accuracy has been reported in women of childbearing age, and at both extremes of age regardless of gender. Many studies have concluded that CT assists in the diagnosis of appendicitis in patients with atypical or nonspecific findings on clinical examination.

Thus, computed tomography should not be considered the standard of care for the diagnosis of appendicitis. Further research is needed to identify sub-groups of patients who may benefit from CT. Therefore, it would be better to offer surgery for all patients with appendicitis without a delay.

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