Can ruptured appendicitis be detected preoperatively in the ED?

Purpose The purpose of this study is to determine which clinical symptoms/signs and computed tomography (CT) signs can help in distinguishing ruptured from simple appendicitis. Materials and Methods The medical records and CT findings of 202 consecutive patients with surgically proven acute appendicitis were retrospectively reviewed and compared between 2 groups with and without appendiceal rupture. Results Longer duration of symptoms (P < .001), peritoneal sign (P = .004), and higher C-reactive protein (P < .001) are significant clinical factors for predicting appendiceal rupture in acute appendicitis. Abscess, extraluminal air, wall defect, peritoneal enhancement, extraluminal appendolith, phlegmon, localized fluid, fascial thickening, ascites, stool impaction, and 4 patterns of bowel wall thickening (P < .001 to P = .047) are significant CT signs for predicting appendiceal rupture. The appendiceal diameter is larger in patients with ruptured appendicitis than in those with simple appendicitis (13.2 ± 3.2 vs 11.3 ± 2.4 mm, P < .001). The appendolith size is larger in patients with ruptured appendicitis than in those with simple appendicitis (7.1 ± 4.4 vs 5.1 ± 2.8 mm, P = .018). Conclusion Besides some clinical findings, CT scan can accurately determine appendiceal rupture in acute appendicitis and can further demonstrate the presence of local inflammatory mass, facilitating management decision in the emergency department (ED).