Tip appendicitis: clinical implications and management

Abstract Background Tip appendicitis describes a rare condition involving inflammatory changes of the distal appendix. We discuss the significance and management of this entity when it is identified on computed tomography (CT) imaging. Methods CT scans performed at our institution between 2003 and 2...

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Bibliographic Details
Published in:The American journal of surgery 2009-02, Vol.197 (2), p.211-215
Main Authors: Mazeh, Haggi, M.D, Epelboym, Irene, B.A, Reinherz, Jill, M.D, Greenstein, Alexander J., M.D., M.P.H, Divino, Celia M., M.D
Format: Article
Language:English
Subjects:
Abdomen
Acute appendicitis
Adolescent
Adult
Aged
Appendectomy
Appendicitis
Appendicitis - diagnostic imaging
Appendicitis - pathology
Appendicitis - therapy
Appendix
Biological and medical sciences
Child
Child, Preschool
Complications
Computed tomography
Distal appendicitis
Female
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Histopathology
Humans
Inflammation
Leukocytosis
Male
Medical diagnosis
Medical imaging
Medical sciences
Middle Aged
Other diseases. Semiology
Pathology
Patients
Pediatrics
Radiology
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Surgery
Tip appendicitis
Tomography, X-Ray Computed
Young Adult
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Summary:Abstract Background Tip appendicitis describes a rare condition involving inflammatory changes of the distal appendix. We discuss the significance and management of this entity when it is identified on computed tomography (CT) imaging. Methods CT scans performed at our institution between 2003 and 2007 were reviewed to identify cases of tip appendicitis. Patients were divided into 2 groups, determined by the confirmation of appendicitis on histopathology. Radiological findings and the clinical courses of both groups were documented and compared using univariate analysis. Results Of 18 patients with the CT finding of tip appendicitis, appendicitis was ultimately confirmed in 39%. Patients in this group had a higher rate of right lower quadrant (RLQ) tenderness (100% vs 55%, P = .04), leukocytosis (14.2 vs 10.5, P = .03), and clinical suspicion for acute appendicitis (43% vs 0%, P = .02). There were no complications or re-admissions. Conclusions The CT finding of tip appendicitis can be managed conservatively in a subset of patients with low clinical suspicion for acute appendicitis.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2008.04.016