Print

Print


Mark:
I too share your position for the most part. The yield of plain radiographs,
in most cases of suspected appendicitis, is exceedingly low. Here is my spin
on radiographs in abdominal pain & suspected appendicitis:
 
Good Story         Tenderness        Radiograph(Y/N)        Reason for Xray
Surgical Consult
Y/N                          RLQ                             N
_                          Y
Y/N                          "Rigid"                          Y
r/o free air            Y
Y                             Vague                            N
_                       Observe/labs/IV
N                             None                            N
_                           N
N                            Vague                            Y
r/o constipation      +/-
 
r/o SBO
 
r/o basal pneumonia
 
etc
 
With the ready availability of US and CT, even in "unequivocal" cases of
clinically suspected appendicitis, I see surgeons reluctant to operate,
without these imaging modalities. I do not necessarily oppose this trend.
There are many "mimics" (mesenteric adenitis, adnexal pathology, volvulus,
intussusception  and rarer conditions like omental infarction etc), that can
be ruled out, hence avoiding unnecessary laparotomies.
 
Would welcome comments
 
Jay P.
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html