Possible Appendicitis

  • Heidi H. Richardson
  • Aytekin Oto
  • Randy D. Ernst
  • Michele McElroy
  • David Easter

Laparoscopic appendectomy was the second major laparoscopic operation adopted by many general surgeons. One obvious advantage was the exceptional ability to visualize the remainder of the abdomen, and thereby exclude other causes of right lower quadrant pain in patients with equivocal findings. Thus, laparoscopic appendectomy found early application to women of reproductive age with right lower quadrant pain.

Although some advocate leaving the normal appendix in situ when another cause for the pain was found, most surgeons remove it, reasoning that occult pathology is often found and that the patient benefi ts more from removal. It has thus been diffi cult to demonstrate that laparoscopic appendectomy has reduced the negative appendectomy rate.

As laparoscopic appendectomy found wider use, computed tomography (CT) scan improved in resolution and it became possible to use an appendiceal protocol scan to confi rm or rule out acute appendicitis. The question then arises, should a patient with equivocal symptoms have a CT scan or be taken straight to laparoscopic exploration and appendectomy. That is the issue discussed here.


Acute Appendicitis Laparoscopic Appendectomy Diagnostic Laparoscopy Oral Contrast Acute Abdominal Pain 


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  1. Addiss DG, Shaffer N, Fowler B, Tauxe R. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132(6):910–925.PubMedGoogle Scholar
  2. Antevil J, Rivera L, Langenberg B, Brown C, The influence of age and gender on the utility of computed tomography to diagnose acute appendicitis. Am Surg 2004;70:850–853.PubMedGoogle Scholar
  3. Flum D, McClure TD, Morris A, Koepsell T. Misdiagnosis of appendicitis and the use of diagnostic imaging. J Am Coll Surg 2005;201(6):933–939.CrossRefPubMedGoogle Scholar
  4. Gaitan H, Eslava-Schmalbach J, Gomez P. Cost effectiveness of diagnostic laparoscopy in reproductive aged females suffering from non-specific acute low abdominal pain. Rev Salud Publica 2005;7(2):166–179.Google Scholar
  5. Golash V, Wilson PD. Early laparoscopy as a routine procedure in the management of acute abdominal pain. Surg Endosc 2005;19:882–885.CrossRefPubMedGoogle Scholar
  6. Hershko DD, Sroka G, Bahouth H, Ghersin E, Mahajna A, Krausz MM. The role of selective computed tomography in the diagnosis and management of suspected acute appendicitis. Am Surg 2002;68(11):1003–1007.PubMedGoogle Scholar
  7. Nakhgevany KB, Clarke LE. Acute appendicitis in women of childbearing age. Arch Surg 1986;121:1053–1055.PubMedGoogle Scholar
  8. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on the treatment of patients and use of hospital resources. N Engl J Med 1998;338(3):141–146.CrossRefPubMedGoogle Scholar
  9. Rao PM, Feltmate CM, Rhea JT, Schulick AH, Novelline RA. Helical computed tomography in differentiating appendicitis and acute gynecologic conditions. Obstet Gynecol 1999;93:417–421.CrossRefPubMedGoogle Scholar
  10. Sauerland S, Agresta F, Bergamaschi R, et al. Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 2006;20:14–29.CrossRefPubMedGoogle Scholar
  11. Van den Broek WT, Bijnen AB, VanEerten PV, DeRuiter P, Gouma DJ. Selective use of diagnostic laparoscopy in patients with suspected appendicitis. Surg Endosc 2000;14:938–941.CrossRefPubMedGoogle Scholar

Suggested Readings

  1. Balthazar E, Rofsky N, Zucker R. Appendicitis: the impact of computed tomography imaging on the negative appendectomy and perforation rates. Am J Gastroenterol 1998;93:768–771.CrossRefPubMedGoogle Scholar
  2. Chung RS, Diaz JJ, Chari V. Efficacy of routine laparoscopy for the acute abdomen. Surg Endosc 1998;12:219–222.CrossRefPubMedGoogle Scholar
  3. Decadt B, Sussman L, Lewis MPN, et al. Randomized clinical trial of early laparoscopy in the management of acute non-specific abdominal pain. Br J Surg 1999;86:1383–1386.CrossRefPubMedGoogle Scholar
  4. Horton M, Counter S, Florence MG, Hart MJ. A prospective trial of computed tomography and ultrasonography for diagnosing appendicitis in the atypical patient. Am J Surg 2000;179:379–381.CrossRefPubMedGoogle Scholar
  5. Jan YT, Yang FS, Huang JK. Visualization rate and pattern of normal appendix on multidetector computed tomography by using multiplanar reformation display. J Comput Assist Tomogr 2005;29:446–451.CrossRefPubMedGoogle Scholar
  6. Jones PF. Suspected acute appendicitis: trends in management over 30 years. Br J Surg 2001;88:1570–1577.CrossRefPubMedGoogle Scholar
  7. Kraemer M, Ohmann C, Leppert R, Yang Q, Macroscopic assessment of the appendix at diagnostic laparoscopy is reliable. Surg Endosc 2000;14;625–633.CrossRefPubMedGoogle Scholar
  8. Larsson PG, Henriksson G, Olsson M, et al. Laparoscopy reduces unnecessary appendicectomies and improves diagnosis in fertile women. Surg Endosc 2001;15:200–202.CrossRefPubMedGoogle Scholar
  9. Majewski WD. Long-term outcome, adhesions, and quality of life after laparoscopic and open surgical therapies for acute abdomen: follow-up of a prospective trial. Surg Endosc 2005;19:81–90.CrossRefPubMedGoogle Scholar
  10. Moberg AC, Ahlberg G, Leijonmarck CE, et al. Diagnostic laparoscopy in 1043 patients with suspected acute appendicitis. Eur J Surg 1998;164:833–840.CrossRefPubMedGoogle Scholar
  11. Moberg AC, Montgomery A. Introducing diagnostic laparoscopy in patients with suspected acute appendicitis. Surg Endosc 2000;14:942–947.CrossRefPubMedGoogle Scholar
  12. Mun S, Ernst RD, Chen K, Oto A, et al. Rapid CT diagnosis of acute appendicitis with IV contrast material. Emerg Radiol 2006;12:99–102.CrossRefPubMedGoogle Scholar
  13. Navez B, d’Udekem Y, Cambier E, Richir C, de Pierpont B, Guiot P. Laparoscopy for management of nontraumatic acute abdomen. World J Surg 1995;19:382–387.CrossRefPubMedGoogle Scholar
  14. Neumayer L, Kennedy A. Imaging in appendicitis: a review with special emphasis on treatment of women. Obstet Gynecol 2003;102(6):1404–1409.CrossRefPubMedGoogle Scholar
  15. Oto A, Ernst RD, et al. Right-lower-quadrant pain and suspected appendicitis in pregnant women: evaluation with MR imaging—initial experience. Radiology 2005;234: 445–451.CrossRefPubMedGoogle Scholar
  16. Pieper R, Kager L, Nasman P. Acute appendicitis: a clinical study of 1018 cases of emergency appendectomy. Acta Chir Scand 1982;148:51–62.PubMedGoogle Scholar
  17. Rennie ATM, Ctytherlerigh M, Theodoroupolou K, Farouk R. A prospective audit of 300 consecutive young women with an acute presentation of right iliac fossa pain. Ann R Coll Surg Engl 2006;88:140–413.CrossRefPubMedGoogle Scholar
  18. Thorell A, Grondal S, Schedvins K, Wallin G. Value of diagnostic laparoscopy in fertile women with suspected appendicitis. Eur J Surg 1999;165:751–754.CrossRefPubMedGoogle Scholar
  19. Van Dalen R, Bagshaw PF, Dobbs BR, Robertson GM, Lynch AC, Frizelle FA. The utility of laparoscopy in the diagnosis of acute appendicitis in women of reproductive age. Surg Endosc 2003;17:1311–1313.CrossRefPubMedGoogle Scholar
  20. Warren O, Kinross J, Paraskeva P, Darzi A. Emergency laparoscopy—current best practice. World J Emerg Surg 2006;1:24.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Heidi H. Richardson
    • 1
  • Aytekin Oto
    • 2
  • Randy D. Ernst
    • 3
  • Michele McElroy
    • 4
  • David Easter
    • 5
  1. 1.Department of SurgeryUniversity of IowaIowa CityUSA
  2. 2.The University of Texas Medical BranchGalvestonUSA
  3. 3.Department of Diagnostic RadiologyThe University of Texas M. D. Anderson Cancer CenterHoustonUSA
  4. 4.University of California, San DiegoSan DiegoUSA
  5. 5.Department of Clinical SurgeryUniversity of California at San DiegoSan DiegoUSA

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