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Monday, July 4, 2011

Acute Appendicitis A Clinician's Dilemma?

Posted by Prahallad Panda on 9:37 PM Comments

Many times the clinical features of acute appendicitis are nonspecific, inconclusive and closely mimic other diseases that makes preoperative diagnosis difficult.
The common routine investigations like blood tests and urine tests does not yield good support to confirm the diagnosis. Commonly employed ultrasonogram, though best in good hands, still may not confirm or dismiss the diagnosis of acute appendicitis.
It is the clinician who has to depend heavily on his/her clinical acumen and experience to decide whether to operate a particular case; wait and watch or manage the case in some other line.
That may result in patients thought to have appendicitis undergo appendectomy, whereas those with a low clinical suspicion for appendicitis do not. To reduce morbidity and mortality risks, it is desirable to have a low fatality rate at appendectomy, but this must be balanced against minimizing the rate of negative findings at appendectomy through appropriate patient selection.
Computed tomography (CT) has been used in an attempt to improve preoperative diagnosis of appendicitis, but sometimes fails to do so and sometimes may not be available in some stations.A cat scan demonstrating acute appendicitis (n...Image of Appendix in CT
The advent of multidetector CT (MDCT) has created new hope for near flawless preoperative diagnosis. According to the results of an analysis of MDCT findings reported in the June 21 issue of the Annals of Internal Medicine, it appears to be more sensitive and specific; and can be the standard of care for suspected appendicitis in adults,
"Use of preoperative computed tomography for suspected acute appendicitis has dramatically increased since the introduction of ...MDCT scanners," write Perry J. Pickhardt, MD, from the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues.
"Multidetector computed tomography is a useful test for routine evaluation of suspected appendicitis in adults," the study authors conclude.
Multidetector CT provides the radiologist with unparalleled capabilities for detailed analysis of normal anatomy and pathology. Unlike classic single detector spiral CT where slice selection was determined prior to the study and was fixed, with multidetector CT there is more flexibility as with each individual detector bank a range of possible variable slice thickness can be obtained which can be selected even after the study is completed.
The article is originally posted in Medscape General Surgery
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