Beyond the commonest: right lower quadrant abdominal pain is not always appendicitis

ABSTRACT

Background

Despite acute appendicitis is the most common underlying etiology of the acute abdomen, a considerable list of other pathologies should be considered; despite sharing almost the same clinical presentation. This study aimed to re-enhance the importance and sensitivity of CT scan as a solitary imaging tool, in the evaluation of patients with acute right lower abdominal pain.

Patients and methods

It is a retrospective study of the last 1000 patients, referred with acute right lower abdominal pain for CT scan examination. Biphasic CT scan abdomen protocol was applied for all.

Results

Cecal carcinoma was detected in three patients (0.3%), epiploic appendicitis in five (0.5%), omental infarct in two (0.2%), appendicular mucocele in two (0.2%), appendicular NET in one (0.1%), cecal diverticulitis in four (0.4%), Chron’s disease in six (0.6%), intussusception in one (0.1%) and FB in one (0.1%) and appendicular perforation in one (0.1%), acute simple appendicitis 398 (39.8%) and 577 (57.7%) were unremarkable.

Conclusion

Despite acute appendicitis is the most common cause of the acute abdomen, many other surgical and non-surgical etiologies should also be considered, with a higher sensitivity of CT as a solitary diagnostic tool of imaging.

KEYWORDS:

• Appendicitis
• appendagitis
• omental infarct
• mucocele
• chron’s disease
• foreign body

Authors contribution

Mahmoud Agha: was the editor and supervisor of data collection, editing the manuscript, and corresponding for publication.

Mohammed Eid: Performance of all radiological investigations, as well as revising the edited manuscript draft.

Maha Sallam: Lab consultant doing all necessary lab investigations for the patients; like creatinine clearance; WBC and ESR counts.

Compliance with ethical standards

This study was conducted according to the protocol, good clinical practice, principle, and the declaration of Helsiniki statements. The ethics committee of the administration of the group of Al- Mana General Hospitals had approved the study protocol and all steps, and assigned informed consents were obtained from all participant candidates.

Disclosure statement

The authors declare that they have no conflict of interest.

Additional information

Funding

This study was supported by the authors, they did not receive any fund of any kind.