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Appendicitis & CT

Avi Roy Shapira trauma-list@trauma.org
Tue, 15 Apr 2003 10:43:57 +0300 (IDT)


Surely there is a limited place to CT in the diagnosis of acute lower
quadrant abdominal pain. I think we all agree to that.  

What I, with Doug and Eric, argue is that one should reserve the CT for
the obscure cases.  Even then it should be delayed. 

If the case is not clear cut, we usually admit the patient for
observation. The majority of observed patients simply get better, and go
home in 24h with no operation and no CT.  Few declare themselves and get
an appendectoy; fewer still remain obscure and these get a CT.

The practice which I and other responders do not condone is the routine CT
of anyone with RLQ pain, often ordered before a surgeon had even seen the
patient. 

Avi 

On Mon, 14 Apr 2003, Ronald Simon wrote:

> I don't get this. There are clearly some cases where the diagnosis is a 
> slam dunk and no further studies necessary. But there are times when it 
> is not. This is where 10-20% neg AP rate comes from. If you can do a 
> test that will significantly reduce this negative rate why not use it? I 
> would personally rather have a CT than a neg exploration as i assume my 
> patients feel the same way.
> Ron
> 
> Douglas Geehan wrote:
> 
> >>  To say the use of all CTs in acute AP is wrong is an overstatement.
> >> Ron Simon
> >> Dir of Trauma
> >> Jacobi Medical Center
> >
> >
> >
> > I would agree with this statement; howver, we have been discussing the 
> > use of CT for appendicitis (kind of neat since we're on the trauma-L; 
> > I guess that answers the question about segregated trauma/ gen surgery 
> > call...) specifically.  My personal view is that you request a CT when 
> > you think the patient does not have appendicitis.  As I tell my 
> > residents, "If you are confident enough to put appendicitis as the 
> > reason for the CT on the requisition form, the patient just needs an 
> > operation".
> >
> > Doug
> >
> 
> 
> 
> 
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==========================================================================
Aviel Roy-Shapira, M.D.              Soroka University Hospital &
Dept. of Surgery A. and              Ben-Gurion University Medical School 
the Critical Care Unit               POB 151, Beer Sheva, Israel
 
email:avir@bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390