The role of computerized tomography in the diagnosis of acute appendicitis in patients with negative ultrasonography findings and a low Alvarado score.

Abstract

BACKGROUND: We aimed to identify the role of computerized tomography (CT) in the differential diagnosis of acute appendicitis in patients with a low Alvarado score and negative ultrasonography findings. METHODS: Fifty-two cases who underwent appendectomy (December 2004-September 2008) were included. All patients had an Alvarado score of 4-6 together with negative ultrasonography findings; preoperative abdominal CT examination results were available in all patients. CT results were compared with intraoperative and pathological findings. RESULTS: The mean age of the cases was 31±4 years (range 11 to 71 years). The mean Alvarado score was 4.9. CT results were in favor of acute appendicitis in 34 of 52 cases. Of these 34 patients, acute appendicitis was confirmed by pathological findings in 31, whereas acute appendicitis could not be confirmed in the remaining three cases (8.2%). In 15 of 18 cases without CT findings of appendicitis, intraoperative and pathological findings were also in agreement; however, the remaining three cases had acute appendicitis. Based on the results of the recent studies, sensitivity and specificity of CT in the diagnosis of acute appendicitis were 91.2% and 83.3%, respectively. CONCLUSION: To avoid unnecessary appendectomies in suspected acute appendicitis cases with a low Alvarado score and negative ultrasonography findings, CT may be used as a complementary diagnostic tool.