Journal of Gastrointestinal Surgery

, Volume 11, Issue 11, pp 1417–1422 | Cite as

Computed Tomography in the Diagnosis of Acute Appendicitis: Definitive or Detrimental?

  • Sandeepa Musunuru
  • Herbert Chen
  • Layton F. Rikkers
  • Sharon M. Weber



Utilization of computed tomography (CT) scans in patients with presumed appendicitis was evaluated at a single institution to determine the sensitivity of this diagnostic test and its effect on clinical outcome.


Adult patients (age > 17 years) with appendicitis were identified from hospital records. Findings at surgery, including the incidence of perforation, were correlated with imaging results.


During a 3-year period, 411 patients underwent appendectomy for presumed acute appendicitis at our institution. Of these patients, 256 (62%) underwent preoperative CT, and the remaining 155 (38%) patients did not have imaging before the surgery. The time interval between arrival in the emergency room to time in the operating room was longer for patients who had preoperative imaging (8.2 ± 0.3 h) compared to those who did not (5.1 ± 0.2 h, p < 0.001). Moreover, this possible delay in intervention was associated with a higher rate of appendiceal perforation in the CT group (17 versus 8%, p = 0.017).


Preoperative CT scanning in patients with presumed appendicitis should be used selectively as widespread utilization may adversely affect outcomes. The potential negative impact of CT imaging includes a delay in operative intervention and a potentially higher perforation rate.


Appendicitis Diagnosis Perforation Imaging CT 


  1. 1.
    Antevil JL, Rivera L, Langenberg BJ, Hahm G, Favata MA, Brown CVR. Computed tomography-based clinical diagnostic pathway for acute appendicitis: Prospective validation. J Am Coll Surgeon 2006;203:849–856.CrossRefGoogle Scholar
  2. 2.
    Bendeck SE, Nino-Murcia M, Berry GJ, Jeffery RB. Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology 2002;225:131–136.PubMedCrossRefGoogle Scholar
  3. 3.
    Old JA, Dusing RW, Yap W, Dirks J. Imaging for suspected appendicitis. Am Fam Phys 2005;71:71–78.Google Scholar
  4. 4.
    Bijnen, CL, van den Broek, WT, Bijnen, AB, de Ruiter, P, Gouma, DJ. Implications of removing a normal appendix. Dig Surg 2003;20:215–221.PubMedCrossRefGoogle Scholar
  5. 5.
    Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resource. N Engl J Med 1998;338:141–146.PubMedCrossRefGoogle Scholar
  6. 6.
    Horton MD, Counter SF, Florence MG, Hart MJ. A prospective trial of computed tomography and ultrasonography for diagnosing appendicitis in the atypical patients. Am J Surg 2000;179:379–381.PubMedCrossRefGoogle Scholar
  7. 7.
    McGory ML, Zingmond DS, Nanayakkara D, Maggard MA, Ko CY. Negative appendectomy rate: influence of CT scans. Am Surgeon 2005;71:803–808.PubMedGoogle Scholar
  8. 8.
    Bickell NA, Aufses AH, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surgeon 2006;202:401–406.CrossRefGoogle Scholar
  9. 9.
    Ditillo MF, Dziura JD, Rabinovici R. Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg 2006;244:656–660.PubMedCrossRefGoogle Scholar
  10. 10.
    Lee, SL, Walsh, AJ, Ho, HS. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg 2001;136:556–562.PubMedCrossRefGoogle Scholar
  11. 11.
    Hong, JJ, Cohn, SM, Ekeh, AP, Newman, M, Salama, M, Leblang, SD. A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. Surg Infect 2004;5:223–224.CrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    Menes TS, Aufses AH, Rojas M, Bickell NA. Increased use of computed tomography does not harm patients with acute appendicitis. Am Surgeon 2006;4:326–329.Google Scholar
  14. 14.
    Mittal VK, Goliath J, Sabir M, Patel R, Richards BF, Alkalay I, ReMine S, Edwards M. Advantages of focused helical computed tomographic scanning with rectal contrast only vs triple contrast in the diagnosis of clinically uncertain acute appendicitis. Arch Surg 2004;139:495–500.PubMedCrossRefGoogle Scholar
  15. 15.
    Walker S, Haun W, Clark J, McMillin K, Zeren F, Gilland T. The value of limited computed tomography with rectal contrast in the diagnosis of acute appendicitis. Am J Surg 2000;180:450–455.PubMedCrossRefGoogle Scholar
  16. 16.
    Torbati SS, Guss DA. Impact of helical computed tomography on the outcomes of emergency department patients with suspected appendicitis. Acad Emerg Med 2003;10:823–829.PubMedCrossRefGoogle Scholar
  17. 17.
    Hershko DD, Sroka G, Bahouth H, Ghersin E, Mahajna A, Krausz MM. The role of selective computed tomography in the diagnosis and management of suspected acute appendicitis. Am Surgeon 2002;68:1003–1007.PubMedGoogle Scholar
  18. 18.
    in’t Hof KH, van Lankeren W, Krestin GP, Bonjer HJ, Lange JF, Becking WB, Kazemier G. Surgical validation of unenhanced helical computed tomography in acute appendicitis. Br J Surg 2004;91:1641–1645.PubMedCrossRefGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Sandeepa Musunuru
    • 1
  • Herbert Chen
    • 1
  • Layton F. Rikkers
    • 1
  • Sharon M. Weber
    • 1
  1. 1.Department of SurgeryUniversity of WisconsinMadisonUSA

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