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Quick GuideAppendix Pain? Appendicitis, Surgery, and More
Imaging studies to diagnosis appendicitis
An abdominal x-ray may detect the fecalith (the hardened and calcified, pea-sized piece of stool that blocks the appendiceal opening) that may be the cause of appendicitis. This is especially true in children. Nevertheless, the presence of a fecalith can occur without appendicitis.
An ultrasound is a painless procedure that uses sound waves to provide images to identify organs within the body. Ultrasound can identify an enlarged appendix or an abscess. Nevertheless, during appendicitis, an enlarged inflamed appendix or abscess can be seen in only 50% of patients. Therefore, not seeing the appendix during an ultrasound does not exclude appendicitis. Ultrasound also is helpful in women because it can exclude the presence of conditions involving the ovaries, Fallopian tubes and uterus (pelvic inflammatory disease, PID) that can mimic appendicitis.
A barium enema is an X-ray test in which liquid barium is inserted into the colon from the anus to fill the colon. This test can, at times, show an impression on the colon in the area of the appendix where the inflammation from the adjacent inflammation impinges on the colon. Barium enema also can exclude other intestinal problems that mimic appendicitis, for example Crohn's disease.
Computerized tomography (CT) scan
In patients who are not pregnant, a CT scan (a type of X-ray study) of the area of the appendix is useful in diagnosing appendicitis and peri-appendiceal abscesses as well as in excluding other diseases inside the abdomen and pelvis that can mimic appendicitis.
Laparoscopy is a surgical procedure in which a small fiberoptic tube with a camera is inserted into the abdomen through a small puncture made on the abdominal wall. Laparoscopy allows a direct view of the appendix as well as other abdominal and pelvic organs. If appendicitis is found, the inflamed appendix can be removed with the laparoscope. The disadvantage of laparoscopy compared to ultrasound and CT is that it requires a general anesthetic.
There is no one test that will diagnose appendicitis with certainty. Therefore, the approach to suspected appendicitis may include a period of observation, tests as previously discussed, or surgery.