Computed tomographic features associated with acute appendicitis in patients presenting with right lower quadrant abdominal pain at Sansai Hospital, Chiang Mai Province
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Abstract
BACKGROUND: Acute appendicitis is a common condition in patients presenting with right lower abdominal pain. Computed tomography (CT) is a highly accurate diagnostic tool; however, data from the Sansai Hospital network on CT imaging characteristics associated with histopathological confirmation remain limited.
OBJECTIVE: To investigate CT imaging characteristics associated with acute appendicitis among patients presenting with right lower abdominal pain at Sansai Hospital, Chiang Mai.
METHODS: This retrospective case-control study analyzed medical records from Sansai Hospital between October 1, 2023, and September 30, 2024. A total of 229 patients with pathologically confirmed appendicitis and 229 controls were systematically selected. Data were collected in three parts: 1) general information, 2) CT findings including 11 characteristics and 3) histopathological results. Data were analyzed using descriptive and inferential statistics, including comparison of proportions, univariable, and multivariable analyses.
RESULTS: Almost all CT characteristics showed statistically significant differences (p<0.001–0.005), except for adjacent thickening of the intestinal wall (p=0.248). Univariable analysis demonstrated significant associations with appendicitis, including appendiceal diameter ≥6.75 mm (OR 6.34, 95% CI: 5.43–7.36, p<0.001), fluid around the appendix (OR 2.49, 95% CI: 1.78–3.19, p<0.001), appendicolith (OR 1.27, 95% CI: 1.05-4.70, p=0.006), and enlarged lymph nodes around the appendix (OR 2.11, 95% CI: 1.26–2.96, p<0.001). Multivariable analysis identified appendiceal diameter ≥6.75 mm (OR 6.25, 95% CI: 5.25–7.25, p<0.001) and fluid around the appendix (OR 2.18, 95% CI: 1.89-3.72, p=0.006) as independent predictors.
CONCLUSIONS AND RECOMMENDATIONS: Most CT characteristics are significantly associated with acute appendicitis. Sansai Hospital should integrate CT findings with clinical assessment in suspected cases to reduce misdiagnosis and implement standardized reporting to improve diagnostic accuracy. Further studies are recommended to refine diagnostic protocols.
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