Acute gangrenous appendicitis-diagnosis by spiral CT

Material-method: twenty-two patients, aged 22-67 are presented. They were admitted in the outpatient department of our hospital with clinical and laboratory findings suggestive of acute appendicitis. All patients were examined by CT after the oral administration of contrast material. The imaging findings were confirmed intraoperatively. Results: a common imaging finding in all patients that were examined by spiral CT, was the enlargement of the appendix with periappendiceal and right paracolic fissure fluid collections. Intraluminal air-bubbles were demonstrated in 19 patients (86.3%) and calcified faecaliths in 16 (72.7%). The wall of the inflamed appendix was demonstrated abnormally thin in 15 patients (68.2%) while thickening of the appendiceal wall was detected in 7 patients. In 15 patients localized peritonitis’ imaging findings were demonstrated by hazy periappendiceal and pericaecal fat, as well as stranding of the area. Diffuse peritonitis was demonstrated in 7 patients as diffusely hazy peritoneal fat stranding with fluid collections in the Douglas pouch. In 13 patients spiral CT detected diffuse inflammation of the right colon and terminal ileum, demonstrated by thickening of their walls. Finally, obstructive ileus was demonstrated in 4 patients. Conclusion: spiral CT is a valuable method, appropriate for the immediate diagnosis of gangrenous appendicitis, which represents a serious complication of acute appendicitis. The specific imaging findings of spiral CT, make early diagnosis and early operative management possible. These imaging findings are especially taken into account, in order to present some specific imaging diagnostic characteristics for acute gangrenous appendicitis.