A new radiographic sign of acute appendicitis: fecal loading in the cecum for differential diagnosis of acute appendicitis in comparision with other abdominal inflammatory diseases.A prospective study

• Main Authors: Andy Petroianu, Luiz Ronaldo Alberti, Renata Indelicato Zac
• Format: Article
• Language: English
• Published: Instituto Israelita de Ensino e Pesquisa Albert Einstein 2007-12-01
• Series: Einstein (São Paulo)
• Subjects: Fecal impaction; Differential diagnosis; Appendicitis/radiography; Acute abdomen/radiography; Cecum
• Online Access: http://www.einstein.br/revista/arquivos/PDF/676-Einstein_P1_Vol5N4_Miolo_Pag%20337%20a%20342.pdf

Objective: The purpose of this investigation was to verify theimportance of the radiographic sign of fecal loading in the cecum forthe differential diagnosis of acute appendicitis. Methods: A total of470 consecutive patients of both sexes was admitted to hospital dueto acute abdomen and pain in the right flank and prospectively studied.The patients were divided as follows: Group 1 (n = 170) – diagnosedwith acute appendicitis and subdivided into two subgroups: Subgroup1A – (n = 100) – patients submitted to an abdominal radiographicstudy a few hours before surgical treatment, Subgroup 1B – (n = 70)– patients submitted to two radiographic studies of the abdomen, onebefore the surgical procedure and the other on the next day; Group 2(n = 100) – patients of both sexes with right nephrolithiasis submittedto an abdominal radiography during the episode of pain caused by thecalculus; Group 3 (n = 100) – women diagnosed with right acuteinflammatory pelvic disease that underwent an abdominal radiographicstudy during the pain crisis; Group 4 (n = 100) – patients of both sexeswho underwent surgery due to acute cholecystitis and were submittedto abdominal radiography during the pain episode that preceded thesurgical procedure. Results: The sign of fecal loading in the cecumwas present in 97 patients of Subgroup 1A, in 68 patients of Subgroup1B, in 19 patients of Group 2, in 12 patients of Group 3 and in 13patients of Group 4. During the postoperative period the radiographicsign disappeared in 66 of the 68 cases who presented the sign. Thesensitivity of the radiographic sign for acute appendicitis was 97.05%and specificity was 85.33%. The positive predictive value for acuteappendicitis was 78.94% and its negative predictive value was 98.08%.Conclusion: The radiographic image of fecal loading in the cecum isassociated with acute appendicitis. The image usually disappears soonafter the appendix is removed. This sign is uncommon in other acuteinflammatory diseases of the right side of the abdomen.