Acute gangrenous appendicitis-diagnosis by spiral CT

Abstract

Aim: Aim of the study is to demonstrate the usefulness and
validity of spiral CT in the evaluation and diagnosis of acute
gangrenous appendicitis, a serious complication of acute
appendicitis.
Material-method: twenty-two patients, aged 22-67 are presented.
They were admitted in the outpatient department
of our hospital with clinical and laboratory findings suggestive
of acute appendicitis. All patients were examined
by CT after the oral administration of contrast material.
The imaging findings were confirmed intraoperatively. Results:
a common imaging finding in all patients that were
examined by spiral CT, was the enlargement of the appendix
with periappendiceal and right paracolic fissure
fluid collections. Intraluminal air-bubbles were demonstrated
in 19 patients (86.3%) and calcified faecaliths in
16 (72.7%). The wall of the inflamed appendix was demonstrated
abnormally thin in 15 patients (68.2%) while
thickening of the appendiceal wall was detected in 7 patients.
In 15 patients localized peritonitis’ imaging findings
were demonstrated by hazy periappendiceal and pericaecal
fat, as well as stranding of the area. Diffuse peritonitis
was demonstrated in 7 patients as diffusely hazy
peritoneal fat stranding with fluid collections in the Douglas
pouch. In 13 patients spiral CT detected diffuse inflammation
of the right colon and terminal ileum, demonstrated
by thickening of their walls. Finally, obstructive
ileus was demonstrated in 4 patients. Conclusion:
spiral CT is a valuable method, appropriate for the immediate
diagnosis of gangrenous appendicitis, which represents
a serious complication of acute appendicitis. The
specific imaging findings of spiral CT, make early diagnosis
and early operative management possible. These
imaging findings are especially taken into account, in order
to present some specific imaging diagnostic characteristics
for acute gangrenous appendicitis.
Key words: Diagnosis, gangrenous, appendicitis, spiral-CT,
findings