Making the Diagnosis of Acute Appendicitis: Do More Preoperative CT Scans Mean Fewer Negative Appendectomies? A 10-year Study

Coursey, Courtney A.; Nelson, Rendon C.; Patel, Mayur B.; Cochran, Courtney; Dodd, Leslie G.; DeLong, David M.; Beam, Craig A.; Vaslef, Steven N.

doi:10.1148/radiol.09082298

Cited by 177 publications

(137 citation statements)

References 34 publications

Supporting

Mentioning

127

Contrasting

Unclassified

Order By: Relevance

“…Our NAR is comparable to other studies [14][15][16][17]. Various authors have reported that the highest incidence of NAR occurs in females of the reproductive age group (15-49 years) [5,6,13,18]. Although we also recorded a higher incidence in this population, the highest incidence was found in young girls aged 11-20 years.…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Joshi

Alam

et al. 2014

Indian J Surg

View full text Add to dashboard Cite

Negative appendectomy remains a concern in current surgical practice. Data from the developing world is scarce. Data of appendectomies during the last 5 years were analyzed. Interval and incidental appendectomies were excluded. The demographic details, presenting complaints, clinical signs, and investigations performed were recorded in a predesigned proforma. The data were critically analyzed. Six hundred eighty-five appendectomies were performed during the period. One hundred eighty-five patients with a normal appendix were identified on histopathology. Sixty-seven patients with incidental or interval appendectomies were excluded. Thus, 118 patients had appendectomies performed erroneously. All these patients with presumed diagnosis of acute appendicitis were operated on by resident surgeons. Records of 17 patients could not be retrieved. The most common symptom was abdominal pain (100 %), and the commonest sign was right iliac fossa tenderness (93 %). Most of the patients underwent USG to supplement the diagnosis. CT scan and diagnostic laparoscopy were not performed. The negative appendectomy rate was 17.2 % (12.4 % in males; 33.3 % in females). The highest incidence of negative appendectomy was in females aged 11-20 years (66.7 %). The rate of negative appendectomy at our institute is comparable with the world statistics. More diligence is required in making the clinical diagnosis of acute appendicitis, especially in young females. The use of C-reactive protein and CT scan may decrease the negative appendectomy rate.

show abstract

Section: Discussionsupporting

confidence: 89%

“…This leads to the removal of the normal appendix in patients presumed to be having AA. The reported negative appendectomy rate (NAR) varies from 4 to 45 %, with the highest incidence in women of the reproductive age group [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Joshi

Alam

et al. 2014

Indian J Surg

View full text Add to dashboard Cite

show abstract

“…The authors showed that the number of preoperative CT examinations in a 10-year period increased from 18.5 % to 93.2 % causing the rate of negative appendectomies to drop from 16.7 % to 8.7 % [28]. Multiple studies compared the diagnostic accuracy of lowdose CT and standard-dose CT in the case of suspected appendicitis [21, 29 -31].…”

Section: Resultsmentioning

confidence: 99%

Imaging of Appendicitis in Adults

Karul

Berliner

Keller

et al. 2014

Fortschr Röntgenstr

View full text Add to dashboard Cite

Three imaging modalities are available for the diagnosis of acute appendicitis: ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Transabdominal ultrasound should be the first-line imaging test. Abdominal CT is superior to US and is required immediately in patients with atypical clinical presentation of appendicitis and suspected perforation. However, low-dose unenhanced CT is equal to standard-dose CT with intravenous contrast agents in the detection of five signs of acute appendicitis (thickened appendiceal wall more than 2?mm, cross-sectional diameter greater than 6?mm, periappendicitis, abscess, and appendicolith). MRI is necessary in pregnant women and young adults. This review illustrates the principles of state-of-the-art imaging techniques and their clinical relevance. Key Points: ??US is the basic diagnostic method in case of suspected appendicitis. ??CT is necessary in patients with atypical presentation of appendicitis. ??MRI should be the first-line imaging test in pregnant women. Citation Format: ??Karul M, Berliner C, Keller S et?al. Imaging of Appendicitis in Adults. Fortschr R?ntgenstr 2014; 186: 551???558

show abstract

“…retrospective study, preoperative CT could not localise aNENs in any of ten patients studied (Coursey et al 2010). Moreover, SRI with 111 In-pentetreotide (Octreoscan) has not been found to be useful in identifying small NENs , Kloppel et al 2009, Kwekkeboom et al 2009), but it has been successful for visualising extrahepatic and extra-abdominal tumour spread; SRI has been suggested in all patients with a known NEN except for aNENs measuring !1 cm in diameter .…”

Section: Imaging Featuresmentioning

confidence: 88%

“…There are a few cases in which RHC was the initial surgical intervention when the neoplasm was grossly evident and the diagnosis was made preoperatively (Deeg et al 2003, Gilboa et al 2008, Coursey et al 2010, Murray et al 2014.…”

Section: Treatmentmentioning

confidence: 99%

Appendiceal neuroendocrine neoplasms: diagnosis and management

Alexandraki¹,

Kaltsas²,

Grozinsky‐Glasberg³

et al. 2015

Endocrine-Related Cancer

View full text Add to dashboard Cite

Gastrointestinal neuroendocrine neoplasms (GI-NENs) are increasingly being recognised, while appendiceal NENs (aNENs) currently constitute the third most common GI-NEN. Appendiceal NENs are generally considered to follow an indolent course with the majority being localised at diagnosis. Thus, the initial surgical approach is not that of a planned oncological resection. Due to the localised nature of the disease in the majority of cases, subsequent biochemical and radiological assessment are not routinely recommended. Histopathological criteria (size, mesoappendiceal invasion, Ki-67 proliferation index, neuroand angio-invasion) are mainly used to identify those patients who are also candidates for a right hemicolectomy. Goblet cell carcinoids are a distinct entity and should be treated as adenocarcinomas. Despite the absence of any substantial prospective data regarding optimal management and follow-up, recent consensus statements and guidelines have been published. The purpose of this review is to overview the published studies on the diagnosis and management of appendiceal NENs and to suggest a possible management protocol.

show abstract

Making the Diagnosis of Acute Appendicitis: Do More Preoperative CT Scans Mean Fewer Negative Appendectomies? A 10-year Study

Abstract: Rising utilization of preoperative CT and advances in technology coincided with a decrease in the negative appendectomy rate for women 45 years and younger but not in men of any age or women older than 45 years.

Cited by 177 publications

References 34 publications

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized?

Imaging of Appendicitis in Adults

Appendiceal neuroendocrine neoplasms: diagnosis and management

Contact Info

Product

Resources

About