Follow-up Study Following Conservative Therapy for Appendicitis Diagnosed Using CT Examinations and CT Findings Predicting Recurrence of Symptoms

Keiwa Kin, Kazuhiro Iwase, Jun Higaki, Shoki Mikata, Makoto Miyazaki, Tonsok Kim*, Etsuo Inoue* and Wataru Kamiike

Department of Surgery and Radiology*, Rinku General Medical Center, Izumisano Municipal Hospital

The purpose of the present study was to determine the recurrence rate of symptoms suggesting acute appendicitis following conservative therapy and feasible CT findings for prediction of recurrence from follow-up of conservatively treated cases in which thediagnosis of acute appendicitis was confirmed by CT. Subjects and Methods: Between December 1997 and June 2002, we studied 233 patients diagnosed with acute appendicitis confirmed by CT. Follow-up of at least 6 months was done in the 62 cases treated conservatively. Results: 1) Recurrent right lower abdominal pain was recognized in 14 (33%) of 43 patients treated conservatively and whose follow-up was completed; appendectomy was done in 9 (21%) and histological examinations of surgically resected specimens showed acute appendicitis in 8 (19%). 2) No significant difference was seen between recurrent and non recurrent cases in the development of positive fecal stones or elevated CT values around the appendix on CT at initial conservative treatment. Appendix enlargement exceeding 9 mm in diameter or ascites was recognized in CT at initial conservative therapy more often in recurrent than non recurrent cases. Summary: The recurrence rate of acute appendicitis diagnosed by CT following conservative therapy was 19-33%. Caution must therefore be exercised regarding the possible recurrence of acute appendicitis after conservative therapy in cases with enlarged appendix or ascites on CT at the initiation of conservative therapy.

Key words
appendicitis, recurrence, conservative therapy, CT

Reprint requests
Kazuhiro Iwase Department of Surgery, Rinku General Medical Center, Izumisano Municipal Hospital
2-23 Rinku-Orai Kita, Izumisano, 598-8577 JAPAN

Accepted
December 17, 2004

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