Can ruptured appendicitis be detected preoperatively in the ED?
OBJECTIVE
The purpose of this study is to determine which clinical symptoms/signs and computed tomography (CT) signs can help in distinguishing ruptured from simple appendicitis.


METHODS
The medical records and CT findings of 202 consecutive patients with surgically proven acute appendicitis were retrospectively reviewed and compared between 2 groups with and without appendiceal rupture.


RESULTS
Longer duration of symptoms ( P < .001), peritoneal sign ( P = .004), and higher C-reactive protein ( P < .001) are significant clinical factors for predicting appendiceal rupture in acute appendicitis. Abscess, extraluminal air, wall defect, peritoneal enhancement, extraluminal appendolith, phlegmon, localized fluid, fascial thickening, ascites, stool impaction, and 4 patterns of bowel wall thickening ( P < .001 to P = .047) are significant CT signs for predicting appendiceal rupture. The appendiceal diameter is larger in patients with ruptured appendicitis than in those with simple appendicitis (13.2 +/- 3.2 vs 11.3 +/- 2.4 mm, P < .001). The appendolith size is larger in patients with ruptured appendicitis than in those with simple appendicitis (7.1 +/- 4.4 vs 5.1 +/- 2.8 mm, P = .018).


CONCLUSIONS
Besides some clinical findings, CT scan can accurately determine appendiceal rupture in acute appendicitis and can further demonstrate the presence of local inflammatory mass, facilitating management decision in the emergency department (ED).
Lin
Chung-Jung
CJ
Department of Radiology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei 112, Taiwan, ROC.
Chen
Jen-Dar
JD
Tiu
Chui-Mei
CM
Chou
Yi-Hong
YH
Chiang
Jen-Huey
JH
Lee
Chen-Hsen
CH
Chang
Cheng-Yen
CY
Yu
Chun
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000175:diagnosis*; D001065:Appendix / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011859:Radiography; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity