Clinical and tomographic findings of acute appendicitis in adults

Abstract

Appendicitis is the acute inflammation of the vermiform appendix, characterized by abdominal pain, nausea/vomiting, and fever, and is considered the most common surgical emergency. The diagnosis is clinical, supplemented by biochemical parameters and, if necessary, a computed tomography scan (CTS). A CTS may be requested to confirm the diagnosis following an inconclusive ultrasound. The objective of this study is to describe the clinical and biochemical parameters of acute appendicitis, as well as to identify the most common characteristics on CTS.

A retrospective study was conducted at the Italian Hospital in Córdoba between January and May 2023. It included adults over 18 years old with suspected symptomatic appendicitis who underwent an abdominal CTS. Data recorded included age, gender, duration of symptoms, fever, white blood cell count, nausea/vomiting, abdominal rigidity, C-reactive protein (CRP) levels, and rebound tenderness. The studied tomographic findings included an increase in appendiceal diameter, increased periappendiceal fat density, periappendiceal fluid accumulation, the presence of an appendicolith, perforation, peritonitis, or gangrene.

A total of 29 patients were studied, with a mean age of 50.66 ± 16.66 years (range, 18-81), and 59% were female. 38% of patients had a fever, and the duration of symptoms was 35.21 ± 44.75 hours (range, 5-240). CRP levels were 6.99 ± 7.41 mg/dL (range, 0.28-28.18), and white blood cell count was 13.82 ± 3.75 x 10^3 mm^3 (range, 7.1-22.68). All patients experienced abdominal pain, 41% had abdominal rebound tenderness, 7% had abdominal rigidity, and 52% had nausea/vomiting. In abdominal CTS, the appendiceal diameter measured 10.72 ± 2 mm (range, 8-15), with 17% showing an appendicolith and 3% showing peritonitis, but no cases of gangrene or perforation. Predominant CTS findings included periappendiceal fat accumulation (90%) and periappendiceal fluid presence (31%).

In conclusion, patients with a higher number of symptoms/signs and abnormal inflammatory laboratory parameters were more likely to exhibit tomographic findings such as increased density of periappendiceal fat planes, periappendiceal fluid accumulation, and an enlarged appendiceal diameter, without peritoneal involvement, indicating early-stage disease. CTS imaging is a valuable tool for diagnosing acute appendicitis; however, clinical evaluation remains the best ally for making a presumptive diagnosis.

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