Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 6/2016

01-06-2016 | Original Article

Should Oral Contrast Be Omitted in Patients with Suspected Appendicitis?

Authors: Lily Saadat, Irene Helenowski, David Mahvi, Anne-Marie Boller

Published in: Journal of Gastrointestinal Surgery | Issue 6/2016

Login to get access

Abstract

Background

Acute appendicitis is one of the most common surgical emergencies. Our study evaluated patients given the diagnosis of appendicitis and reviewed their workup and clinical outcomes. We specifically focused on the use of oral contrast followed by appendectomy.

Methods

We retrospectively reviewed all adult patients given an ICD-9 code for appendicitis at Northwestern Memorial Hospital between January 2000 and September 2010. Complication rates, time to the operating room, and length of hospital stay were compared between patients who received a CT scan and those who did not during the hospitalization for appendicitis.

Results

Average time from Emergency Department to the operating room was found to be statistically longer for patients who underwent a CT scan (10 h: 3, 1548) versus those who did not (6 h: 2, 262) (p < 0.0001). There were 19 patients who had the complication of pneumonia and 4 patients who were diagnosed with acute respiratory distress syndrome postoperatively. Patients who underwent a CT scan and received oral contrast had a statistically higher number of both complications (p < 0.0001).

Conclusions

The use of oral contrast is not necessary for an accurate diagnosis of appendicitis and may be associated with higher complication rates, longer hospital stays, and poor outcomes.
Literature
1.
Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United States: study period 1993–2008. J. Surg. Res. Jun 15 2012;175(2):185–190.
2.
Berg ER, Mehta SD, Mitchell P, Soto J, Oyama L, Ulrich A. Length of stay by route of contrast administration for diagnosis of appendicitis by computed-tomography scan. Acad. Emerg. Med. Oct 2006;13(10):1040–1045.
3.
Guss DA, Richards C. Comparison of men and women presenting to an ED with acute appendicitis. Am. J. Emerg. Med. Jul 2000;18(4):372–375.
4.
Horattas MC, Guyton DP, Wu D. A reappraisal of appendicitis in the elderly. Am. J. Surg. Sep 1990;160(3):291–293.
5.
Pittman-Waller VA, Myers JG, Stewart RM, et al. Appendicitis: why so complicated? Analysis of 5755 consecutive appendectomies. Am. Surg. Jun 2000;66(6):548–554.
6.
Von Titte SN, McCabe CJ, Ottinger LW. Delayed appendectomy for appendicitis: causes and consequences. Am. J. Emerg. Med. Nov 1996;14(7):620–622.
7.
Papandria D, Goldstein SD, Rhee D, et al. Risk of perforation increases with delay in recognition and surgery for acute appendicitis. J. Surg. Res. Oct 2013;184(2):723–729.
8.
Raman SS, Lu DS, Kadell BM, Vodopich DJ, Sayre J, Cryer H. Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review. AJR Am J Roentgenol. Jun 2002;178(6):1319–1325.
9.
Nelson DW, Causey MW, Porta CR, et al. Examining the relevance of the physician’s clinical assessment and the reliance on computed tomography in diagnosing acute appendicitis. Am. J. Surg. Apr 2013;205(4):452–456.
10.
Shaligram A, Pallati P, Simorov A, Meyer A, Oleynikov D. Do you need a computed tomographic scan to evaluate suspected appendicitis in young men: an administrative database review. Am. J. Surg. Dec 2012;204(6):1025–1030; discussion 1030.
11.
Collaborative S, Cuschieri J, Florence M, et al. Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann. Surg. Oct 2008;248(4):557–563.
12.
Coursey CA, Nelson RC, Patel MB, et al. Making the diagnosis of acute appendicitis: do more preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology. Feb 2010;254(2):460–468.
13.
Kim K, Kim YH, Kim SY, et al. Low-dose abdominal CT for evaluating suspected appendicitis. N Engl J Med. Apr 26 2012;366(17):1596–1605.
14.
Raman SS, Osuagwu FC, Kadell B, Cryer H, Sayre J, Lu DS. Effect of CT on false positive diagnosis of appendicitis and perforation. N Engl J Med. Feb 28 2008;358(9):972–973.
15.
Rao PM, Rhea JT, Rattner DW, Venus LG, Novelline RA. Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann. Surg. Mar 1999;229(3):344–349.
16.
Peck J, Peck A, Peck C, Peck J. The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis. Am. J. Surg. Aug 2000;180(2):133–136.
17.
Jacobs JE, Birnbaum BA, Macari M, et al. Acute appendicitis: comparison of helical CT diagnosis focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material. Radiology. Sep 2001;220(3):683–690.
18.
Anderson BA, Salem L, Flum DR. A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults. Am. J. Surg. Sep 2005;190(3):474–478.
19.
Drake FT, Alfonso R, Bhargava P, et al. Enteral Contrast in the Computed Tomography Diagnosis of Appendicitis: Comparative Effectiveness in a Prospective Surgical Cohort. Ann. Surg. Oct 10 2013.
20.
Glauser J, Siff J, Emerman C. Emergency Department Experience With Nonoral Contrast Computed Tomography in the Evaluation of Patients for Appendicitis. Journal of patient safety. Sep 27 2013.
21.
Kepner AM, Bacasnot JV, Stahlman BA. Intravenous contrast alone vs intravenous and oral contrast computed tomography for the diagnosis of appendicitis in adult ED patients. Am. J. Emerg. Med. Nov 2012;30(9):1765–1773.
22.
Laituri CA, Fraser JD, Aguayo P, et al. The lack of efficacy for oral contrast in the diagnosis of appendicitis by computed tomography. J. Surg. Res. Sep 2011;170(1):100–103.
23.
Latifi A, Labruto F, Kaiser S, Ullberg U, Sundin A, Torkzad MR. Does enteral contrast increase the accuracy of appendicitis diagnosis? Radiol. Technol. Mar-Apr 2011;82(4):294–299.
24.
Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD. Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Ann. Emerg. Med. Jan 2010;55(1):51–59 e51.
25.
Mun S, Ernst RD, Chen K, Oto A, Shah S, Mileski WJ. Rapid CT diagnosis of acute appendicitis with IV contrast material. Emergency radiology. Mar 2006;12(3):99–102.
26.
Drake FT, Alfonso R, Bhargava P, et al. Enteral contrast in the computed tomography diagnosis of appendicitis: comparative effectiveness in a prospective surgical cohort. Ann. Surg. Aug 2014;260(2):311–316.
27.
Malone AJ, Jr., Wolf CR, Malmed AS, Melliere BF. Diagnosis of acute appendicitis: value of unenhanced CT. AJR Am J Roentgenol. Apr 1993;160(4):763–766.
28.
Mahmoud M, McAuliffe J, Kim HY, et al. Oral contrast for abdominal computed tomography in children: the effects on gastric fluid volume. Anesth. Analg. Nov 2010;111(5):1252–1258.
29.
Morcos SK. Review article: Effects of radiographic contrast media on the lung. Br. J. Radiol. May 2003;76(905):290–295.
30.
Trulzsch DV, Penmetsa A, Karim A, Evans DA. Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography. South. Med. J. Dec 1992;85(12):1255–1256.
Metadata
Title
Should Oral Contrast Be Omitted in Patients with Suspected Appendicitis?
Authors
Lily Saadat
Irene Helenowski
David Mahvi
Anne-Marie Boller
Publication date
01-06-2016
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 6/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3110-6

Other articles of this Issue 6/2016

Journal of Gastrointestinal Surgery 6/2016 Go to the issue

Original Article

Management of Primary Gastrointestinal Non-Hodgkin Lymphomas: a Population-Based Survival Analysis

Evidence-Based Current Surgical Practice

Current Evidence in Image-Guided Liver Surgery

Original Article

Pancreatic Metastasectomy—an Analysis of Survival Outcomes and Prognostic Factors

Review Article

Pharmacological management to prevent ileus in major abdominal surgery: a systematic review and meta-analysis

GI Image

The Progression of Cholelithiasis to Gallstone Ileus: Do Large Gallstones Warrant Surgery?

Original Article

Obturator Canal Lymph Node Metastasis from Rectal Carcinoid Tumors: Total Mesorectal Excision May Be Insufficient