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Imaging in Appendicitis: A Review With Special Emphasis on the Treatment of Women

From the Departments of Surgery and Radiology, Salt Lake City VA Healthcare System, and the University of Utah, Salt Lake City, Utah.

Address reprint requests to: Leigh Neumayer, MD, MS, Department of Surgery, 50 N Medical Drive, Salt Lake City, UT 84132; E-mail: leigh.neumayer{at}hsc.utah.edu.

OBJECTIVE: Acute abdominal pain in women often presents the clinician with a diagnostic dilemma, especially if it is lower abdominal pain. Appendicitis is frequently entertained as a diagnosis, but until recently, the gold standard diagnostic procedure was operation, carrying a high false-negative rate. In recent years, computed tomographic (CT) scan has been advocated as a diagnostic aid. The purpose of this systematic review was to evaluate the accuracy of CT scan in diagnosing appendicitis.

DATA SOURCES: Investigators searched PubMed between January and July 2003 using the terms "CT scan" and "appendicitis" with the limits "All adults 19+ years" and "English [language]." In addition, reference lists of all obtained articles were reviewed for other potential citations.

METHODS OF STUDY SELECTION: All prospective studies of adults published in English were considered.

TABULATION, INTEGRATION, AND RESULTS: Initial searches and reviews yielded 248 citations. Twenty-three of the citations reported prospective studies; only two of these were randomized studies. Prospective studies report sensitivities ranging from 77% to 100%, specificities ranging from 83% to 100%, and accuracies ranging from 88% to 98% for the diagnosis of acute appendicitis. Information gained from CT scans in patients with suspected appendicitis results in alternative diagnosis in 6% to 36%. These values are similar for both men and women.

CONCLUSION: The data support routine use of CT scan in both men and women for the diagnosis of appendicitis.

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