The role of imaging in the diagnosis of acute appendicitis. Report of 273 patients

Abstract

Background. The clinical diagnosis of acute appendicitis is not always obvious. The rate of “unnecessary” interventions remains rather high. Imaging therefore plays an important role in the diagnosis of this surgical emergency, particularly in atypical cases. The aim of this work is to elucidate the role of imaging in the diagnosis of this pathology. Materials and methods. This is a retrospective study that was conducted between January 2013 and December 2019. Different elements were considered, functional signs, physical examination data, biological and radiological examinations, intraoperative findings, and pathological results. The certainty of the diagnosis of acute appendicitis was established on the result of the anatomopathological examination of the surgical specimen, or failing that, on an evocative intraoperative aspect. Results. A number of 273 patients was included. Among our patients there were 142 men and 131 women. Average age was 32 years old. Right iliac fossa pain was the main complaining sign, found in 89.7% of cases. Ultrasound was performed in 217 patients confirming the diagnosis in 77% of cases. CT was performed in 134 patients, confirming the diagnosis in 84.3% of cases. A total of 227 patients were operated, i.e., 83.2%. The rest were discharged after monitoring in the department. Accuracy of ultrasound was 71.4%. Diagnostic accuracy of CT was 82.1%. Conclusion. Clinical presentation is often polymorphic. Imaging is often necessary. First-line abdominal ultrasound is preferred. Abdominal CT scan is to be requested as first line imaging modality in the elderly or obese subject.