CT scanning in the management of acute appendicitis

Early Uncomplicated Appendicitis—Who Can We Treat Nonoperatively?

This study evaluated nonoperative treatment for mild appendicitis and reviewed selection criteria to be used in introducing this option into clinical practice. A retrospective review of 73 consecutive cases of appendicitis treated by a single surgeon from 2011 to 2013 was completed. Patients who were diagnosed with mild appendicitis meeting the criteria of an APPENDICITIS scoring algorithm proposed in this manuscript were considered for nonoperative management. An additional 17 patients with mild appendicitis were offered and successfully treated nonoperatively between 2014 and 2016 and reviewed. Of these original 73 patients, 37 had moderate to severe appendicitis and directly underwent appendectomy. The remaining patients were diagnosed with mild appendicitis and considered eligible for nonoperative management. Of these, 14 patients were offered nonoperative therapy. Thirteen responded successfully; one patient responded partially, but later opted for surgery. In 2014, this scoring system and preliminary results were shared with the other surgeons in our department. Nonoperative management was then selectively adopted by a few of the surgeons from 2014 to 2016 with another 17 patients (APPENDICITIS score of 0 or 1) being offered and successfully managed nonoperatively. Patients with mild or early appendicitis can be successfully managed nonoperatively. A proposed APPENDICITIS scoring system may provide a helpful mnemonic for successfully selecting patients for this option.

Clinical value of CT in early diagnosis and treatment of acute abdomen

It is critical to select a fast and accurate method for the early diagnosis and treatment of acute abdomen. CT displays important application value in the early diagnosis and treatment of acute abdomen because of its convenient and intuitive features, advantages in terms of sensitivity and specificity compared with other methods, and the relatively low economic cost. In this paper, we summarize the application value of abdominal CT in the early diagnosis and treatment of acute abdomen by analyzing the characteristics of acute abdomen, comparing CT examination with other methods, and presenting several specific cases.

Diagnostic value of CT versus BUS in detection of acute appendicitis

AIM: To compare the diagnostic value of CT versus BUS in detection of acute appendicitis.

METHODS: Clinical data for 120 patients with pathologically verified acute appendicitis who underwent CT ( n = 60) or BUS ( n = 60) were retrospectively analyzed to compare the value of CT and BUS in diagnosis and differential diagnosis of this disease. The sensitivity of the two modalities in the diagnosis of acute appendicitis was compared.

RESULTS: The sensitivity of CT and BUS in the diagnosis of acute appendicitis was 93% and 60%, respectively. The diagnostic accuracy of CT for acute appendicitis was significantly better than that of BUS (P < 0.05). However, there was no significant difference in diagnostic accuracy between CT and BUS for other pathologic types of appendicitis.

CONCLUSION: CT should be the first choice for acute appendicitis, especially in patients with a negative BUS examination.