Ip Chantelle, Wang Edward H, Croft Michael, Lim Wanyin
Royal Adelaide Hospital, Port Road, Adelaide 5000, Australia.
Flinders Medical Centre, Flinders Dr, Bedford Park 5042, Australia.
Radiol Res Pract. 2021 Nov 22;2021:7191348. doi: 10.1155/2021/7191348. eCollection 2021.
This manuscript aims to investigate the amount of intraluminal gas in acute, nonperforated appendicitis identified on computed tomography (CT) in diagnosing gangrenous appendicitis.
This is a retrospective observational, case-control study with consecutive data collected at a tertiary institution over a two-year period, of patients with CT-diagnosed acute appendicitis who subsequently went on for surgery within 48 hours. Patients who were less than 16 years old, who had an interval between CT and surgery of more than 48 hours, or with CT evidence of appendiceal perforation were excluded. Images were independently assessed by 3 radiologists for intraluminal gas, and the results were then correlated with reference standards obtained from surgical and histopathology reports for the diagnosis of nongangrenous versus gangrenous appendicitis. The sensitivity, specificity, and predictive values of CT intraluminal gas in gangrenous appendicitis were calculated.
Our study identified 93 patients with nonperforated acute appendicitis who underwent surgery within the stated timeframe. Intraluminal gas in the appendix was identified in 26 patients (28%), of which 54% had macroscopic and/or microscopic evidence of gangrenous appendicitis. This is in contrast to the subgroup of patients who did not have intraluminal gas (72%), of which only 33% had gangrenous appendicitis. The specificity of intraluminal gas for gangrenous appendicitis is 79%, with a negative predictive value of 86% and likelihood ratio of 1.85.
In cases of established acute appendicitis, the presence of intraluminal gas is a moderately specific sign for gangrenous complication. This is worth reporting as it can help prognosticate and triage patients accordingly, for a timelier surgical management and a better outcome.
本手稿旨在研究计算机断层扫描（CT）诊断急性非穿孔性阑尾炎时阑尾腔内气体量在诊断坏疽性阑尾炎中的作用。
这是一项回顾性观察性病例对照研究，在两年时间内，于一家三级医疗机构连续收集数据，研究对象为CT诊断为急性阑尾炎且随后在48小时内接受手术的患者。排除年龄小于16岁、CT检查与手术间隔超过48小时或有阑尾穿孔CT证据的患者。3名放射科医生独立评估图像中的腔内气体情况，然后将结果与手术和组织病理学报告中用于诊断非坏疽性与坏疽性阑尾炎的参考标准进行对比。计算CT腔内气体对坏疽性阑尾炎的敏感性、特异性和预测值。
我们的研究确定了93例在规定时间内接受手术的非穿孔性急性阑尾炎患者。26例（28%）患者阑尾腔内有气体，其中54%有坏疽性阑尾炎的宏观和/或微观证据。相比之下，阑尾腔内无气体的患者亚组（72%）中，只有33%有坏疽性阑尾炎。腔内气体对坏疽性阑尾炎的特异性为79%，阴性预测值为86%，似然比为1.85。
在已确诊的急性阑尾炎病例中，腔内气体的存在是坏疽性并发症的一个中等特异性体征。这一点值得报告，因为它有助于对患者进行预后评估和分类，从而实现更及时的手术管理并获得更好的治疗效果。
