Department of Genaral Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul-Türkiye.
Department of Radiology, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Oct;30(10):722-728. doi: 10.14744/tjtes.2024.50363.
Acute appendicitis is a common cause of acute abdominal pain necessitating surgical intervention. While the traditional treatment has been urgent appendectomy, recent studies suggest that an antibiotics-first approach can be safe for uncomplicated cases. Classifying appendicitis into uncomplicated and complicated categories is crucial for guiding treatment decisions and predicting patient outcomes. This study aims to evaluate the distinct imaging findings associated with uncomplicated appendicitis and its complicated subtypes-phlegmonous, gangrenous, and perforated appendicitis-to aid in differential diagnosis.
This retrospective observational study was conducted from January 2014 to December 2023 and included 1,250 patients (492 women, 758 men) who underwent an appendectomy with available pathology results. After excluding 56 patients with normal pathology, 52 with non-appendicitis pathologies, and 48 with inaccessible computed tomography (CT) images, 1,094 patients were analyzed. CT images were evaluated for appendiceal diameter, wall thickness, cecal wall thickness, periappendiceal fat stranding, effusion, lymphadenopathy, intraluminal and free periappendiceal air, mucosal hyperenhancement, and the presence of appendicolith.
The diameter of the appendix, along with the presence of periappendiceal air, effusion, and intraluminal appendicolith, were significantly higher in the perforated appendicitis group compared to other groups (p<0.05). Periappendiceal fat stranding, evaluated as a binary variable, did not show significant differences among the groups. Appendiceal wall thickness was higher in the perforated group and lower in the non-perforated gangrenous group compared to the uncomplicated group (p<0.05). No significant correlation was found for mucosal hyperenhancement between the appendicitis subgroups. Intraluminal air, though normal in a healthy appendix, was a specific predictor of complicated appendicitis when combined with other findings.
This study provides a detailed analysis of distinct imaging findings associated with uncomplicated and complicated appendicitis. Key differentiators such as appendiceal diameter, periappendiceal air, effusion, and intraluminal appendicolith are crucial for accurate diagnosis. The findings highlight the importance of these parameters in distinguishing various types of appendicitis, offering valuable insights for clinical practice. Future prospective studies and advanced imaging techniques are needed to validate these findings and enhance the diagnosis and management of acute appendicitis and its complications.
急性阑尾炎是一种常见的急性腹痛病因，需要手术干预。虽然传统的治疗方法是紧急阑尾切除术，但最近的研究表明，对于单纯性病例，抗生素优先治疗方法是安全的。将阑尾炎分为单纯性和复杂性类别对于指导治疗决策和预测患者预后至关重要。本研究旨在评估与单纯性阑尾炎及其复杂亚型（蜂窝织炎、坏疽性和穿孔性阑尾炎）相关的不同影像学表现，以帮助鉴别诊断。
这是一项回顾性观察研究，从 2014 年 1 月至 2023 年 12 月进行，共纳入 1250 例（女性 492 例，男性 758 例）接受阑尾切除术且有病理结果的患者。排除 56 例病理正常、52 例非阑尾炎病理和 48 例无法获取计算机断层扫描（CT）图像的患者后，共分析了 1094 例患者。对 CT 图像评估阑尾直径、壁厚度、盲肠壁厚度、阑尾周围脂肪条纹、渗出液、淋巴结病、腔内和游离阑尾周围积气、黏膜增强和阑尾结石的存在。
穿孔性阑尾炎组阑尾直径、阑尾周围积气、渗出液和腔内阑尾结石的存在显著高于其他组（p<0.05）。作为二项变量评估的阑尾周围脂肪条纹在各组之间没有显著差异。穿孔组阑尾壁厚度高于单纯性组，坏疽性组阑尾壁厚度低于单纯性组（p<0.05）。阑尾黏膜增强在各阑尾炎亚组之间无显著相关性。腔内空气在健康阑尾中是正常的，但与其他发现结合时是复杂阑尾炎的特异性预测指标。
本研究详细分析了与单纯性和复杂性阑尾炎相关的不同影像学表现。阑尾直径、阑尾周围积气、渗出液和腔内阑尾结石等关键区别因素对准确诊断至关重要。这些发现强调了这些参数在区分各种类型阑尾炎中的重要性，为临床实践提供了有价值的见解。需要进一步的前瞻性研究和先进的影像学技术来验证这些发现，并提高急性阑尾炎及其并发症的诊断和管理水平。
