Oral contrast is often used with computed tomography (CT) for the diagnosis of appendicitis. This adjunct adds time to evaluation, not all patients can tolerate enteric bolus, and the diagnostic advantages have not been well defined. Therefore, we reviewed our experience to evaluate the impact of oral contrast on diagnostic efficiency and its impact on the patient.
After obtaining IRB approval, a retrospective review was conducted on patients who underwent CT with oral contrast for the indication of appendicitis over the last 4 years. Data recorded included demographics, CT results, emergency room course, operative findings, and pathology interpretation. All images were reviewed to identify presence/absence of contrast at or beyond the terminal ileum.
There were 1561 patients, of whom, 652 (41.8%) were diagnosed with appendicitis and 909 (58.2%) were not (non-appendicitis). Contrast was identified at least to the level of the terminal ileum in 72.4% of the entire population. The contrast was present in 76.2% of the non-appendicitis patients and 67.0% of the appendicitis patients (P = 0.01). Mean time from oral contrast administration to CT imaging was 105.5 min, which was longer in patients with appendicitis (112.2 min) compared with non-appendicitis patients (100.9 min) (P = 0.01). Emesis of the contrast occurred in 19.3% of those with appendicitis and 12.9% of those without appendicitis (P = 0.001). Nasogastric tubes were placed in 5.8% of those with appendicitis and 5.1% of those without (P = 0.37). Appendicitis was confirmed at operation in 94.3% of those with contrast in the area and 94.4% of those without (P = 1.0). Pathology confirmed appendicitis in 90.6% of those with contrast in the area and 94.0% of those without (P = 0.17).
Nearly 30% of patients receiving oral contrast for the CT diagnosis of appendicitis do not have contrast in the point of interest at the expense of emesis, nasogastric tube placement, and diagnostic delay. These detriments are amplified in patients who have appendicitis. Further, there appears to be no diagnostic compromise in those without contrast in the terminal ileum.
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- Diagnostic accuracy of noncontrast computed tomography for apendicitis in adults: A systematic review.Ann Emergency Med. 2010; 55: 51.e1
- The effect of hospital volume of pediatric appendectomies on the misdiagnosis of appendicitis in children.Pediatrics. 2004; 113: 18
- Imaging evaluation of suspected appendicitis in a pediatric population: Effectiveness of sonography versus CT.AJR Am J Roentgenol. 2000; 175: 977
- A prospective trial of computed tomography and ultrasonography for diagnosing appendicitis in the atypical patient.Am J Surg. 2000; 179: 379
- Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children: Comparison with sonography.AJR Am J Roentgenol. 2001; 176: 31
- Costs and effectiveness of ultrasonography and limited computed tomography for diagnosing appendicitis in children.Pediatrics. 2000; 106: 672
- Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children.JAMA. 1999; 282: 1041
- Unenhanced spiral CT for evaluating acute appendicitis in daily routine. A prospective study.Hepatogastroenterology. 2001; 48: 140
- Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital.AJR Am J Roentgenol. 1998; 171: 997
- Diagnosis of acute appendicitis: Comparison of 5- and 10-mm CT sections in the same patient.Radiology. 2000; 216: 172
- Acute appendicitis: Comparison of helical CT diagnosis-focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material.Radiology. 2001; 200: 683
- Acute appendicitis: Meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease.Radiology. 2008; 249: 97
- A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults.Am J Surg. 2005; 190: 474
- Suspected acute appendicitis: Nonenhanced helical CT in 300 consecutive patients.Radiology. 1999; 213: 341
- Unenhanced helical CT for suspected acute appendicitis.AJR Am J Roentgenol. 1997; 168: 405
- The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis.Am J Surg. 2000; 180: 133
- Prospective comparison of helical CT of the abdomen and pelvis without and with oral contrast in assessing acute abdominal pain in adult emergency department patients.Emerg Radiol. 2006; 12: 150
- Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis.Br J Radiol. 2002; 75: 721
- Comparison of US and unenhanced multi-detector row CT in patients suspected of having acute appendicitis.Radiology. 2005; 236: 527
- Acute appendicitis: Diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings.Eur Radiol. 2007; 17: 2055
- Role of focused appendiceal computed tomography in clinically equivocal acute appendicitis.J Pak Med Assoc. 2006; 56: 200
- Surgical validation of unenhanced helical computed tomography in acute appendicitis.Br J Surg. 2004; 91: 1641
- Acute appendicitis in unenhanced spiral CT: Diagnostic luxury or benefit.Rofo. 1999; 171: 26
Published online: March 14, 2011
Received: December 21, 2010
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.