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Study of Oliak et al for the Diagnosis of Perforated Appendicitis or Gangrenous Based on CT Scan Findings

Description

Once an inflamed appendix perforates or becomes gangrenous the morbidity of acute operative management increases. Oliak et al used CT scanning to identify patients with a perforated or gangrenous appendix who might benefit from initial nonoperative management. The authors are from Harbor-UCLA Medical Center in Torrance, California.


 

Key findings on CT scan associated with perforation:

(1) extraluminal gas

(2) abscess

(3) phlegmon

(4) terminal ileal wall thickening

 

The individual findings have good specificity (88-100%) but poor sensitivity (24-75%). The authors therefore combined the first 3 findings to generate the following rule:

 

If one or more of the following (extraluminal gas, abscess, phlegmon) is present, then the patient is managed as for perforated or gangrenous appendicitis.

 

Performance (Table 4, page 961):

• The sensitivity of the combined rule was 92% with a specificity of 88%.

• The positive predictive value is 96% but the negative predictive value is 74% (2 false positive vs 5 false negative in series).

 


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