Evaluation of perforated and nonperforated appendicitis with CT

Published:September 13, 2004DOI:


      Fifty-three patients with 38 cases of perforated appendicitis and 15 cases of appendicitis without perforation were evaluated based on the computed tomography (CT) appearances of appendiceal diameter, phlegmon, abscess, extraluminal air, appendiceal wall enhancement, lateroconal fascial thickening, appendicolith, bowel wall thickening, ascites, ileal wall enhancement, peritoneal enhancement, periappendiceal fluid, omental haziness, retrocecal appendix, intraluminal air, and the combination of intraluminal air and appendicolith. The result of appendiceal diameter was compared using two-sample Student's t test, and the other CT findings were analyzed by Fisher's Exact Test. Our results showed that appendix was larger in caliber in perforated appendix (P<.05). Direct CT signs (i.e., phlegmon, abscess, and extraluminal air) were more specific for perforated appendicitis (P<.05). Indirect signs (bowel wall thickening, ascites, ileal wall enhancement, intraluminal air, and combined intraluminal air and appendicolith) were also found in higher incidence in appendiceal perforation (P<.05). Appendiceal enlargement and ileal wall enhancement were the two predominant findings in one case of perforation. We concluded that direct and indirect CT appearances can differentiate appendicitis with and without perforation. Indirect signs may be helpful in difficult case.


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        • Fuchs JR
        • Schlamberg JS
        • Shortsleeve MJ
        • Schuler JG
        Impact of abdominal CT imaging on the management of appendicitis: an update.
        J Surg Res. 2002; 106: 131-136
        • Kaiser S
        • Frenckner B
        • Jorulf HK
        Suspected appendicitis in children: US and CT—a prospective randomized study.
        Radiology. 2002; 223: 633-638
        • Wong SK
        • Chan LP
        Helical CT imaging of clinically suspected appendicitis: correlation of CT and histological findings.
        Clin Radiol. 2002; 57: 741-745
        • Lowe LH
        • Penney MW
        • Stein SM
        • Heller RM
        • Neblett WW
        • Shyr Y
        • Hernanz M
        Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children: comparison with sonography.
        AJR. 2001; 176: 31-35
        • Lane MJ
        • Katz DS
        • Ross BA
        • Clautice TL
        • Mindelzun RE
        • Jeffrey RB
        Unenhanced helical CT for suspected acute appendicitis.
        AJR. 1997; 168: 405-409
        • Raman SS
        • Lu SK
        • Kadell BM
        • Vodopich DJ
        • Sayre J
        • Cryer H
        Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review.
        AJR. 2002; 178: 1319-1325
        • Jacobs JE
        • Birnbaum BA
        • Macari M
        • Megibow AJ
        • Israel G
        • Maki DD
        • Aguiar AM
        • Langlotz CP
        Acute appendicitis: comparison of helical CT diagnosis—focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material.
        Radiology. 2001; 220: 683-690
        • Rao PM
        • Rhea JT
        • Novelline RA
        Sensitivity and specificity of individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations.
        J Comput Assist Tomogr. 1997; 21: 686-692
        • Fefferman NR
        • Roche KJ
        • Pinkney LP
        • Ambrosino MM
        • Genieser NB
        Suspected appendicitis in children: focused CT technique for evaluation.
        Radiology. 2001; 220: 691-695
        • Mullins ME
        • Kircher MF
        • Ryan DP
        • Doody D
        • Mullins TC
        • Rhea JT
        • Novelline RA
        Evaluation of suspected appendicitis in children using limited helical CT and colonic contrast material.
        AJR. 2001; 176: 37-41
        • Sivit CJ
        • Dudgeon DL
        • Applegate KE
        • Borisa VJ
        • Berlin SC
        • Morrison SC
        • Myers MT
        • Weinert DM
        • Stallion A
        • Grisoni ER
        Evaluation of suspected appendicitis in children and young adults: helical CT.
        Radiology. 2000; 216: 430-433
        • Jonathan R
        • Brenda B
        • William R
        • Jordan E
        • Howard G
        Use of CT scan in the diagnosis of pediatric acute appendicitis.
        Pediatr Emerg Care. 2000; 16: 241-243
        • Jabra AA
        • Shalaby EI
        • Fishman EK
        CT of appendicitis in children.
        J Comput Assist Tomogr. 1997; 21: 661-666
        • Friedell ML
        • Perez IM
        Is there a role for internal appendectomy in the management of acute appendicitis?.
        Am Surgeon. 2000; 66: 1158-1162
        • Yamini D
        • Vargas H
        • Bongard F
        • Klein S
        • Stamos MJ
        Perforated appendicitis: is it truly a surgical urgency?.
        Am Surgeon. 1998; 64: 970-975
        • Horrow MM
        • White DS
        • Horrow JC
        Differentiation of perforated from nonperforated appendicitis at CT.
        Radiology. 2003; 227: 46-51
        • Oliak D
        • Sinow R
        • French S
        • Udani VM
        • Stamos MJ
        Computed tomography scanning for the diagnosis of perforated appendicitis.
        Am Surgeon. 1999; 65: 959-964
        • Lowe LH
        • Penney MW
        • Scheker LE
        • Perez R
        • Stein SM
        • Heller RM
        • Shyr Y
        • Hernanz SM
        Appendicolith revealed on CT in children with suspected appendicitis: how specific is it in the diagnosis of appendicitis?.
        AJR. 2000; 175: 981-984
        • Rao PM
        • Rhea JT
        • Novelline RA
        Appendiceal and peri-appendiceal air at CT: prevalence, appearance and clinical significance.
        Clin Radiol. 1997; 52: 750-754
        • Zalcman M
        • Van G
        • Lalmand B
        • Braude P
        • Closset J
        • Struyven J
        Delayed enhancement of the bowel wall: a new CT sign of small bowel strangulation.
        J Comput Assist Tomogr. 1996; 20: 379-381
        • Hara H
        • Babyn PS
        • Bourgeois D
        Significance of bowel wall enhancement on CT following blunt abdominal trauma in childhood.
        J Comput Assist Tomogr. 1992; 16: 94-98
        • Horton KM
        • Eng J
        • Fishman EK
        Normal enhancement of the small bowel: evaluation with spiral CT.
        J Comput Assist Tomogr. 2000; 24: 67-71
        • Ruess L
        • Frazier AA
        • Sivit CJ
        CT of the mesentery, omentum, and peritoneum in children.
        Radiographics. 1995; 15: 89-104