RADIOGRAPHIC SIGN OF FECAL LOADING IN THE CECUM FOR DIFFERENTIAL DIAGNOSIS OF ACUTE APPENDICITIS IN COMPARISION WITH OTHER ABDOMINAL INFLAMMATORY DISEASES

Abstract

Objective: The value of plain abdominal radiography in acute appendicitis has not been completely studied. Therefore, the purpose of this investigation was to verify a new radiographic sign: the presence of fecal loading in the cecum. Methods: 470 consecutive patients of both sexes admitted to the hospital due to acute abdominal pain localized in the right flank were prospectively studied. The patients were divided into four groups: Group 1 (n=170) –acute appendicitis – patients submitted to an abdominal radiographic study a few hours before surgical treatment; Group 2 (n=100) – right nephrolithiasis submitted to an abdominal radiography during the episode of pain caused by the lithiasis; Group 3 (n=100) – right acute inflammatory pelvic disease that underwent an abdominal radiographic study during the pain incident; Group 4 (n=100) – acute cholecystitis submitted to abdominal radiography during the pain episode that preceded the surgical procedure. All of the radiographs were plain with an anteroposterior view of the abdomen. Results: The sign of fecal loading in the cecum was present in 165 patients of Group 1,in 19 patients of Group 2, in 12 patients of Group 3 and in 13 patients of Group 4. The sensitivity of the radiographic sign for acute appendicitis was 97,05 % and its specificity was 85,33%. The positive predictive value for acute appendicitis was 78,94 % and its negative predictive value was 98,08%. Conclusions: The radiographic image of fecal loading in the cecum is associated with acute appendicitis. This sign is uncommon in other acute inflammatory diseases of the right side of the abdomen. The absence of this sign makes the diagnosis of acute appendicitis improbable.