The value of limited computed tomography with rectal contrast in the diagnosis of acute appendicitis

Background: Multiple nonrandomized studies demonstrate the accuracy of computed tomography (CT) scan in diagnosing appendicitis. This study compared CT scan with standard management in diagnosing appendicitis. Methods: This was a prospective randomized study of patients who received general surgery consultation for appendicitis. Patients were randomized to receive CT scan or standard management. Results: There were 65 patients in the CT scan group and 63 patients in the standard management group. The sensitivity, specificity, and accuracy of CT scan were 94%, 100%, and 96%, respectively. CT scan positively altered the management in 26% and made alternative diagnoses in 14%. The sensitivity, specificity, and accuracy of the standard management group were 100%, 79%, and 89%, respectively. The standard management group had a negative appendectomy rate of 19%. Conclusions: CT scan with rectal contrast is an effective method for diagnosing appendicitis and should be performed in all patients suspected of having appendicitis