Multispiral computed tomography in the detection and differential diagnosis of acute appendicitis

Purpose. To determine the possibility of MSCT in the differential diagnosis of acute appendicitis.

Materials and methods. MSCT was performed on a multidetector 64-slice computer tomograph Aquilion company Toshiba with multi-phase contrast enhancement. The results of MSCT 108 (100%) patients hospitalized for emergency indications with suspected acute appendicitis in the surgical Department of the “City clinical hospital them M.E. Zhadkevich Of the Department of health of the city of Moscow” were analyzed from July 2017 to July 2018.

Results. The age range of the subjects ranged from 18 to 81 years, including 53 women (49%), 55 men (51%).

CT-picture of acute appendicitis was observed in 23 (21%) patients. In 85 (79%) cases, according to MSCT, no direct signs of inflammatory changes in the Appendix were determined. In this case, acute appendicitis was confirmed during surgery in 22 (20%) cases. A false positive result was obtained in one patient. In a comprehensive examination were diagnosed: acute mesenteric thrombosis -1(1%) case, acute mesadenitis - 1 (1%) case, acute pyelonephritis - 2 (2%) case, concretion of the right ureter -2 (2%) case, hemorrhage in the cyst of the right ovary -1 (1%) case, diverticulitis - 6 (5%) cases, tumors of the blind and ascending intestines - 2 (2%) case. In 68 (63%) cases, patients were discharged without surgery after intestinal colic relief. 2 (2%) patients were operated on with negative MSCT results, as the acute abdominal clinic was preserved. Acute phlegmonous appendicitis was diagnosed intraoperatively. The sensitivity of MSCT in the detection of acute appendicitis in our observations was 91.7%, specificity -98.8%, the prognostic value of the positive result-95.7%, the prognostic value of the negative result - 95.4%.

Conclusion. Multispiral computed tomography is highly informative in the differential diagnosis of acute appendicitis, its use avoids unreasonable surgical interventions.

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