title: Tip appendicitis: clinical implications and management.
abstract: BACKGROUND
  Tip appendicitis describes a rare condition involving inflammatory changes of the distal appendix. We discuss the significance and management of this entity when it is identified on computed tomography (CT) imaging.
  
  
  METHODS
  CT scans performed at our institution between 2003 and 2007 were reviewed to identify cases of tip appendicitis. Patients were divided into 2 groups, determined by the confirmation of appendicitis on histopathology. Radiological findings and the clinical courses of both groups were documented and compared using univariate analysis.
  
  
  RESULTS
  Of 18 patients with the CT finding of tip appendicitis, appendicitis was ultimately confirmed in 39%. Patients in this group had a higher rate of right lower quadrant (RLQ) tenderness (100% vs 55%, P = .04), leukocytosis (14.2 vs 10.5, P = .03), and clinical suspicion for acute appendicitis (43% vs 0%, P = .02). There were no complications or re-admissions.
  
  
  CONCLUSIONS
  The CT finding of tip appendicitis can be managed conservatively in a subset of patients with low clinical suspicion for acute appendicitis.
authors.affiliation: Department of General Surgery, Hadassash-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Haggi
authors.initials: H
authors.lastname: Mazeh
authors.forename: Irene
authors.initials: I
authors.lastname: Epelboym
authors.forename: Jill
authors.initials: J
authors.lastname: Reinherz
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Greenstein
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D055815:Young Adult