Purpose:
To identify whether CT characteristics of acute appendicitis (AA) differ between patients with successful and unsuccessful conservative therapy.
Materials and Methods:
316 CT exams performed in patients with AA between July 2017 and April 2019 were retrospectively reviewed. All patients who were surgically treated within 48 hours of diagnosis (168/316) or presented with complicated appendicitis (10/316) were excluded. Mean age of 130/316 patients included was 28 years (range 12-68), with F\M ratio of 1:1.1. The patients divided into two groups according to their clinical outcome: group A- successful conservative non-surgical treatment and group B- failure of conservative treatment resulting in an appendectomy within one year of initial diagnosis or re-hospitalization. Comparison of CT characteristics included maximum diameter of appendix, extent of appendix involvement, appendix wall thickening and enhancement pattern, major fat stranding, presence of cecal base or ileal bowel wall-thickening, lymphadenopathy and free fluid. Paired samples t-tests, chi-square tests were used for statistical analysis. P-values of <0.05 were considered statistically significant.
Results:
Group A included 90/130 patients (69%), and group B included 40/130 (31%). In-group B mean period for recurrence was 120 days (Median- 94). Twelve patients in group A didn’t receive contrast agent in their CT scan.
There was major increase in extent of appendix involvement (75% vs. 55%, P < 0.05) and free fluid (42% vs. 20%, P < 0.05) in group A compared to group B. In contrast major fat stranding (25% vs. 45%, P < 0.05) and full wall enhancement (36% vs. 55%), were significantly decreased in group A compared to group B (P < 0.05). The rest of the findings were similar in both groups.
Conclusion:
Our findings, may aid in clinical decision when a conservative treatment for uncomplicated AA is considered.
