Tomographic findings of acute appendicitis in patients treated at the general surgery of CMDLT 2018-2023

Abstract

Acute appendicitis (AA) remains a common cause of surgical acute abdomen, and its diagnosis can be challenging, particularly in atypical clinical presentations. Although clinical evaluation is essential, imaging techniques—especially abdominal and pelvic computed tomography (CTAP)—have become fundamental for increasing diagnostic accuracy and identifying complications. This study aimed to describe the typical and atypical tomographic findings in patients with AA treated between 2018 and 2023 at the La Trinidad Teaching Medical Center (CMDLT).

A retrospective, observational, and analytical study was conducted including 100 patients with histologically confirmed AA who underwent preoperative CTAP. Primary signs (appendiceal diameter, wall thickness, presence of appendicolith) and secondary signs (periappendiceal fat stranding, mesenteric lymphadenopathy, free fluid, inflammatory mass, extraluminal gas) were assessed, along with the type of contrast used.

Results showed a predominance of male patients (54%) and a mean age of 44 years. Seventy-five percent presented more than 24 hours after symptom onset. Regarding imaging technique, oral contrast was used in 70% of CTAP studies. The most frequent primary sign was an appendiceal diameter greater than 6 mm (83%), followed by wall thickening greater than 3 mm (72%); appendicolith was identified in 15%. Among secondary signs, mesenteric lymphadenopathy (87%) and periappendiceal fat stranding (82%) were the most common.

In conclusion, tomographic findings were consistent with those reported in current literature, reinforcing CTAP as a high-yield diagnostic tool in AA. However, the study highlights the need to optimize institutional imaging protocols by prioritizing intravenous contrast administration to enhance visualization of inflammatory changes and possible complications.