[Diagnostic aids in acute appendicitis]

Abstract

Acute appendicitis is usually diagnosed solely on clinical grounds. This results in a 15-30% incidence of unnecessary laparotomies and contributes to a perforation rate of 20-35%. The accuracies of eleven diagnostic aids for appendicitis are reviewed. The white blood cell count and straight x-ray of the abdomen are very unreliable. Four other methods, viz leucocyte scintigraphy, peritoneal lavage, barium swallow and scoring systems have not yet been sufficiently investigated. CT scanning may be useful in difficult cases. Four methods have a proven value and are recommended: Ultrasound scanning, computer assessment, laparoscopy and barium enema. Each of the latter are better than clinical assessment alone and can reduce both negative laparotomy rates and the incidence of appendicular perforation. Unaided clinical diagnosis of acute appendicitis is no longer acceptable.