gms | German Medical Science

Introduction: Acute appendicitis is diagnose by clinical examination, ultrasound and laboratory tests. However, ultrasonography may not be sufficient for a definite diagnosis in obese patients and in the case of meteorism. In this study, the clinical relevance of computed tomography to diagnose acute appendicitis, especially in obese patients, was evaluated in a retrospective study.

Materials and methods: Patients suffering from acute pain in the right underbelly were examined for appendicitis by means of clinical examination, ultrasound imaging and laboratory tests. In case of definite diagnostic findings (n=160), appendectomy was accomplished by laparoscopy. In case of negative ultrasonography findings (n=38), patients were reexamined by CT the same day (n=20) or by ultrasound imaging and laboratory tests the next day after admission (n=18).

Results: Patients with negative initial ultrasonography findings (n=38), duration of anamnesis ranged from 12 to 120 hours and 14 (36.8%) of these patients were considered as obese due to their body mass index (BMI ≥30 kg/m²). In comparison, only 7.3% of the patients with positive ultrasonography findings were obese. Among the 20 patients further examined by CT, 17 (85.0%) showed a BMI ≥30 kg/m². Duration of anamnesis ranged from 12 to 48 h. In contrast, among the 18 patients reexamined by ultrasound imaging, only two showed a BMI ≥30 kg/m².

Conclusion: In patients with increased BMI (>30 kg/m²) suffering from acute pain in the right underbelly and short duration of anamnesis, appendicitis was diagnosed by ultrasound imaging only in 45.0% of the cases. Therefore it is advisable to perform directly CT of the abdomen instead of second ultrasound imaging. Compared to admission of patients and reexamination by ultrasound imaging and laboratory tests, the faster diagnosis by initial CT is additionally associated with cost savings in these patients.