Authors:
S. H. H. Kim, S. H. H. Lee, H. W. K. Lim, J. Y. Na, D. L. Choi; Seoul/KP
DOI:
10.1594/ECR03/C-0114
Results
Clinical Findings Patients complained of right lower quadrant pain (n=16), right flank pain (n=8), right upper quadrant pain (n=6), periumbilical pain (n=5), and mild fever (n=6). Anorexia, nausea, vomiting, and diarrhea developed. The mean duration of the symptom was 7.4 days (one day to two months). Twenty three patients had leukocytosis (>10,000/mL). The distribution of initial diagnostic disease included acute appendicitis (n=21), diverticulitis (n=2 ), acute gastroenteritis (n=2), ureter stone (n=2), acute pyelonephritis (n=2), colon cancer (n=2), and irritable bowel syndrome (n=1). One patient developed sepsis.CT Findings The whole length of the inflamed appendix was recognized in 23 patients (69.7%), whereas only a segment of the inflamed appendix was recognized in 7 patients (21.2%). In 3 patients (9.1%), the appendix was not recognized on CT scan. All the visible inflamed appendices were located in posterolateral aspect of the ascending colon. The thickness of inflamed appendix varied from 8mm to 18mm (mean, 13mm) in maximum diameter. Appendicolith was detected in 11 patients. Mesenteric lymph node enlargement was associated in 16 patients. One patient whose appendix was not demonstrated on CT scans revealed extensive perforation of the appendix with abscess and a portion of base of inflamed appendix was visible on operative finding. Two patients with invisible appendix on CT scan revealed abscess without identifiable appendix on operative finding. Periappendiceal inflammatory changes were severe in 18 patients, moderate in 9, mild in 4 and absent in 2 patients. Involved areas of periappendiceal inflammatory changes were in retrocolic area (n=29), paracolic gutter (n=10), anterior pararenal space (n=4), posterior pararenal space (n=5), perirenal space (n=6), mesenteric fat (n=8), subhepatic space (n=1), and adjacent abdominal wall (n=1).
Inflammatory thickening of adjacent fascia was seen in 27 patients (81.8%): lateroconal fascia (n=21), Gerotas fascia (n=23), transversalis fascia (n=2) (Fig. 1). The phlegmon was present in three patients (9.1%) and abscesses were in 16 patients (48.5%). All cases of abscesses were associated with micro- or macro perforation of the appendix (57.6%). The size of the abscesses ranged from 1.4 cm to 18 cm. The abscesses were located in retrocolic space (n=14) (Fig. 2), right paracolic gutter (n=3), subhepatic space (n=3) (Fig. 3, 4), mesentery (n=2), subphrenic (Fig. 5), iliopsoas, perirenal, and posterior pararenal space (n=1, respectively). Thickening of wall (>5mm wall thickness despite adequate lumen distention) of adjacent bowel loop was present in 26 patients (78.8%). There are 22 segments of cecum, 21 ascending colon, 7 terminal ileum.