Appendicitis at the Millennium

Abstract

Acute appendicitis is a common clinical problem. Accurate and prompt diagnosis is essential to minimize morbidity. While the clinical diagnosis may be straightforward in patients who present with classic signs and symptoms, atypical presentations may result in diagnostic confusion and delay in treatment. Helical computed tomography (CT) and graded compression color Doppler ultrasonography (US) are highly accurate means of establishing the diagnosis. These imaging modalities have now assumed critical roles in the treatment of patients suspected to have appendicitis. The purpose of this article is threefold: to provide an update on new information regarding the pathophysiology, clinical diagnosis, and laparoscopic treatment of acute appendicitis; to describe the state-of-the art use of CT and US in diagnosing this disease entity; and to address the role of medical imaging in this patient population.

Ultrasonography in Patients with Suspected Acute Appendicitis

“…Graded compression sonography as popularized by Puylaert [1] superadded with self localization [2] is a readily available, noninvasive, highly accurate means of diagnosing appendicitis and a variety of relevant diaseases [8]. Prospective studies have shown that the overall accuracy of US in diagnosing acute appendicitis ranges between 87-96% (sensitivity 75-90%, specificity 86-100%) with positive and negative predictive values of 91-94% and 89-97% respectively [3,4,5,12]. In experienced hands US significantly improves diagnostic accuracy in suspected appendicitis while reducing the negative laparotomy rate to 8-15% [13].…”

“…The preoperative clinical diagnosis is straightforward in 70-80% cases with an overall negative appendectomy rate of 20-25% [1][2][3][4]. Accurate and prompt diagnosis followed by early surgery are essential to minimize morbidity.…”

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

“…The transverse outer diameter of a normal appendix was 6 mm or less. 6,8 Acute appendicitis was diagnosed when there was an incompressible appendix with a transverse outer diameter of 6 mm or greater and secondary signs, 12 which included a mural thickness of greater than 2 mm and inflamed periappendiceal hyperechoic fat. 6,8 The radiologists who performed sonography subjectively defined equivocal appendicitis when the transverse outer diameter of the appendix measured greater than 6 mm without secondary signs or when they could not identify the connection between tubular structures suggesting the presence of a distended appendix and cecum due to an unusual location of the appendix or a poor sonic window.…”

La apendicitis y su historia

“…Para ello se utiliza la maniobra de Yódice Sammartino (palpación anoparietoabdominal). En los apéndices pelvianos, Handley ha descripto un cuadro que denominó íleo doble, que es la obstrucción del intestino delgado y el colon sigmoides al mismo tiempo [6][7][8][9][10][11][12][13][14][15] .…”

“…Si está ubicado en la fosa ilíaca derecha, por detrás de las asas intestinales, las manifestaciones locales (defensa y contractura) son pobres y el compromiso del tránsito intestinal hará que la afectación apendicular se exprese por un síndrome oclusivo del intestino delgado [6][7][8][9][10] .…”