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Inconclusive abdominal CT findings in pediatric patients with appendicitis: lessons from negative appendectomy cases

Authors Kim Y, Moon S

Received 23 November 2015

Accepted for publication 22 January 2016

Published 23 March 2016 Volume 2016:9 Pages 1—6

DOI https://doi.org/10.2147/RMI.S101126

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Professor Tarik Massoud


Younglim Kim, Suk-Bae Moon

Department of Surgery, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, South Korea

Purpose: Although abdominal computed tomography (ACT) has high sensitivity and specificity in helping to detect appendicitis in pediatric patients, diagnostic challenges still exist for some cases despite undergoing ACT, and negative appendectomies still persist. The aim of this study was to elucidate some ACT findings that support true appendicitis for patients who had inconclusive preoperative ACT findings.
Patients and methods: For the 49 patients whose preoperative ACT diagnoses were inconclusive (ten negative appendicitis; 39 true appendicitis), the ACT findings were retrospectively measured for the following features: appendiceal enlargement, presence of appendicolith or hyperdense materials in the appendix, periappendiceal fat inflammation, periappendiceal fluid collection, appendiceal wall thickening, appendiceal gas, and right lower quadrant lymphadenopathy. These features were compared between true appendicitis and negative appendicitis cases.
Results: The presence of an enlarged appendix of diameter >8 mm or periappendiceal fat inflammation strongly correlated with true appendicitis, while the absence of appendiceal wall thickening or mesenteric lymphadenopathy correlated with negative appendicitis.
Conclusion: If the ACT findings were inconclusive for patients suspected of having appendicitis, factors such as periappendiceal fat inflammation, an enlarged appendix, appendiceal wall thickening, and mesenteric lymphadenopathy should be cautiously assessed to discriminate true appendicitis from negative appendicitis.

Keywords:
inconclusive abdominal CT, acute appendicitis, periappendiceal fat inflammation, appendiceal enlargement, wall thickening, lymphadenopathy

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