Comparison of Abdominal Computerized Tomography and Clinical Findings in Atypical Appendicitis

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.

Comparison of Abdominal Computerized Tomography and Clinical Findings in Atypical Appendicitis

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.

Characteristics of a Focused Assessment with Sonography for Trauma (FAST) in Hollow Viscus Injury

PURPOSE: The usefulness of focused abdominal sonography for trauma (FAST) is now included in the frame work of the advanced trauma life support for examination of thoraco- abdominal trauma. Ultrasonographic screening is controversial in patients with hollow viscus injury. The purpose of this study is to determine the characteristics of emergency trauma sonographic findings in patients with hollow viscus injury. METHODS: All patients with isolated viscus injury after blunt abdominal trauma were retrospectively enrolled in this study during the 5-year period from December 1997 to November 2002. The patients were screened by using ultrasonography and an underwent explolaparotomy. The patients were diagnosed with a hollow viscus injury based on the surgical findings. Patients with viscus injury combined with parenchymal organ injury after abdominal trauma were excluded. Ultrasonographic examinations were performed by the experienced emergency physicians during the trauma resuscitation. RESULTS: Sixty patients were included in this study. The most common injury site was jejunum (23.3%). The common findings of emergency trauma sonography were free fluid collection (56.7%), none of fluid collection (38.3%), free air and fluid collection (3.3%), and free air (1.7%). The presence of mesenteric injury was significantly associated with fluid collection (x2=0009). CONCLUSION: The most common sonographic findings in hollow viscus injury patients after blunt abdominal trauma are free intraperitoneal fluid (anechoic or mixed echo pattern), normal, and free air (reverberation) in that order. Massive intraperitoneal fluid is more often detected in patients who have a viscus injury combined with a ruptured mesenteric vessel.