Helical computed tomography in differentiating appendicitis and acute gynecologic conditions

Objective: To determine the accuracy and effect of helical computed tomogra phy (CT) in women clinically suspected of having either appendicitis or an acute gynecologic condition. Methods: One hundred consecutive nonpregnant women suspected of having appe ndicitis or an acute gynecologic condition prospectively had helical CT. In terpretations were correlated with surgical and pathologic findings (41 cas es) and clinical follow-up for at least 2 months (59 cases). The accuracy f or confirming or excluding both appendicitis and acute gynecologic conditio ns was determined. The effect on patient care was determined by comparing p re-CT plans with actual treatment. Results: Thirty-two women had appendicitis, 15 had acute gynecologic condit ions, 27 had other specific diagnoses, and 26 had nonspecific abdominal pai n. For diagnosing appendicitis or acute gynecologic conditions, CT had 100% and 87% sensitivity, 97% and 100% specificity, 94% and 100% positive predi ctive value, 100% and 98% negative predictive value, and 98% and 98% accura cy, respectively. After CT was done, 36 planned hospital admissions, 25 pla nned hospital observations, and six planned appendectomies were deferred; s ix women had alternative surgical procedures on the basis of CT results. On e patient had an unnecessary appendectomy on the basis of CT findings. Conclusions: Helical CT is an excellent imaging option for differentiating appendicitis from most acute gynecologic conditions. (C) 1999 by The Americ an College of Obstetricians and Gynecologists.