Comparison of Abdominal Computerized Tomography and Clinical Findings in Atypical Appendicitis

Park, Kyung Hye; Lee, Kang Hyun; Kim, Yun Kwon; Won, Ho Kyong; Kim, Seon Hyu; Jang, Yong Soo; Kim, Hyun; Hwang, Sung Oh

Abstract

PURPOSE: The frequency of computerized tomography (CT) for diagnosing of atypical acute appendicitis, as ordered by emergency physicians, was noted. According to abdominal CT findings, the severity of acute appendicitis is divided into six grades that are used for diagnosis and treatment. However, whether or not the laboratory and clinical findings of atypical acute appendicitis have a relation to the grading of abdominal CT scans is unknown. This study was performed to evaluate the correlation between CT grades and symptoms, signs and operative and pathologic findings of atypical acute appendicitis.
METHODS
This study included 412 patients who were admitted and underwent an appendectomy from January 2004 to June 2005. An abdominal and pelvic CT scan was performed in 114 patients who had atypical presentations in the emergency room. The abdominal and pelvic CT scales were correlated with clinical signs, laboratory findings, and pathology reports. The CT scale for appendicitis is a sixgrade scale from normal (grade 0) to periappendiceal abscess (grade 5).
RESULTS
Sixty-six patients were male and 48 were female, and the mean age was 50.7+/-22.0 years old. On the abdominal CT, grade 0 (normal) was 3 patients (2.6%), grade 1 (probable appendicitis) 5 (4.4%), grade 2 (appendicitis) 17 (14.8%), grade 3 (appendicitis with periappendicitis) 47 (40.9%), grade 4 (appendicitis with rupture) 30 (26.1%), and grade 5 (complicated appendicitis) 12 (10.4%). There was no significant difference between CT grades and either local tenderness or rebound tenderness in the right lower quadrant abdomen (p>0.296). However increased body temperature correlated with higher CT grades (p=0.01). There were significant differences in the neutrophil count (p<0.001), but not the white blood cell count (p=0.493). The severity of pathology of acute appendicitis correlated with the CT grade (R=0.468, p=0.004).
CONCLUSION
There was no significant correlation of local and rebound tenderness on right lower quadrant abdomen and of white blood cell count with CT grading in appendicitis, but there was a high correlation of body temperature and of neutrophil counts with the CT grades of appendicitis for patients with atypical appendicitis. The CT grades of appendicitis also correlated with the pathology.