Can peritoneal thickening and enhancement be used to determine perforation in patients with acute appendicitis?

Abstract

Background: Acute appendicitis (AA) is a common cause of abdominal pain in developed countries. In patients with suspected AA, computed tomography (CT) is considered as the gold standard with the highest sensitivity and specificity, and it is also an im-portant modality, especially in patients with complicated AA. In this study, we aimed to evaluate age and laboratory findings, as well as specific CT findings in differentiating between perforated and non-perforated appendicitis.

Methods: We retrospectively analyzed 252 patients diagnosed with AA and underwent appendectomy between November 2015 and December 2019 in Somalia Mogadishu Recep Tayyip Erdogan Education and Research Hospital. Patients under 18 years of age and those with no pre-operative CT scans were excluded from the study. The demographic, laboratory, CT findings, and pathological data of all patients were evaluated.

Results: This study included 80 patients, 32 (40%) classified as perforated appendicitis (Group-1) and 48 (60%) as non-perforated appendicitis (Group-2). The C-reactive protein value was found to be statistically higher in Group-1 than in Group-2 (177.5±118.9 and 100.2±87.3 mg / L, respectively; p=0.001). The appendix lumen diameter (p=0.002), appendix wall defect (p<0.001), peritoneal thickening and enhancement (p<0.001), ascites (p=0.031), intra-abdominal abscess (p=0.003), jejunal thickening (p=0.019), ileal thick-ening (p=0.008), and ileus (p=0.035) values were significantly higher in Group-1. In the binominal logistic regression analysis performed with statistically significant data, an appendiceal wall defect (OR: 0.069, 95% CI=0.014-0.327, p=0.001) and peritoneal thickening and enhancement (OR: 0.131, 95% CI=0.024-0.714, p=0.019) were identified as independent variables for perforated appendicitis.

Conclusion: Among CT findings, appendix wall defects and peritoneal thickening and enhancement play an important role in detecting perforation.

Figure 1

The axial computed tomography images of a 46-year-old male patient diagnosed with perforated appendicitis based on pathological findings, revealing an appendiceal wall defect (a) and an intraluminal appendicolith (b).

Figure 2

The axial contrast-enhanced computed tomography images of a 42-year-old female with perforated acute appendicitis, showing an intraluminal appendicolith (a), intraperitoneal ascites, diffuse abdomino-pelvic smooth peritoneal thickening, and peritoneal enhancement (b).

Figure 3

Axial contrast-enhanced computed tomography images show diffuse peritoneal enhancement (a) and peritoneal thickening (a and b).