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Appendicitis & CT

tony joseph trauma-list@trauma.org
Tue, 15 Apr 2003 23:34:03 +1000

At 11:35 AM 14/04/03 -0500, you wrote:
What concerns me as an ED physician is that I occasionally see surgeons use
a negative test,ie appendix not seen on either ultrasound or CT as somehow
reassurance that the patient doesn't need an appendicectomy ( when the
history and exam suggest otherwise) and so they delay operating until they
have really good going peritonitis.
My understanding is that Ultrasound is less sensitive than CT in
visualising the appendix depending on the study.
Does anyone have any reliable figures on sensitivity and specificity for
both of these modalities in the diagnosis of appendicitis when the clinical
picture is not so clear?
Tony Joseph


I would personally rather have a CT than a neg exploration as i assume 
>> my patients feel the same way.
>> Ron 
>Two things,  one your implication is that it is either or proposition 
>(CT -- neg exploration).  CT is not a panacea for the diagnostic 
>uncertainty of appendicitis.  Second, I'm not stating that CT has no 
>role in the assessment of the patient with abdominal pain.  Quite the 
>contrary.  I am stating that the surgeons should probably be the 
>ordering physician, and after an exam at that.  I am also stating that 
>you get the scan when "something" is not right.  I stand by my 
>statement, however, that if you write appendicitis on the request form, 
>you probably should have just operated.  Won't even get into the can of 
>worms of diagnostic laparoscopy....
>Douglas Geehan, M.D.
>Associate Professor
>Department of Surgery
>University of Missouri-Kansas City
>trauma-list : TRAUMA.ORG
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