CT scans and appendicitis.To the Editor: The December issue of the Journal had an interesting perspective on appendicitis Appendicitis Definition Appendicitis is an inflammation of the appendix, which is the worm-shaped pouch attached to the cecum, the beginning of the large intestine. The appendix has no known function in the body, but it can become diseased. . The CT scan CT scan: see CAT scan. See CAT scan. has usurped the physical diagnostic acumen of all doctors. At my institution the surgeons see few patients before they have received their obligatory CT scans. In our frequent ER visitors we have found some who have had more than twenty abdominal CT scans. The latest rage has been CT scans for kidney stones Kidney Stones Definition Kidney stones are solid accumulations of material that form in the tubal system of the kidney. Kidney stones cause problems when they block the flow of urine through or out of the kidney. . Recently I polled a number of southern surgical residency directors about a new physical diagnostic sign; I found practically no interest in it. The observation by one being he could not remember the last surgical consultation that he did without there being a prior CT report on the chart. Most recently I had a patient come in who was a postmenopausal post·men·o·paus·al adj. Of or occurring in the time following menopause. postmenopausal Change of life Gynecology adjective Referring to the time in ♀ when menstrual periods stop for ≥ 1 yr , thin, easy to examine female who had right lower-quadrant point tenderness, a perfect Rovsing's sign, guarding of the lower abdominal muscles abdominal muscles Clinical anatomy The large muscles of the anterior abdominal wall–external oblique, internal oblique, rectus abdominalis, which help in breathing, support spinal muscles while lifting, and help maintain abdominal organs and GI tract in their , a positive heel tap and a positive rectal shelf examination. There was associated nausea with the pain, a fever of 102, and a 15,000 white blood cell count white blood cell count, n a diagnostic clinical laboratory test to determine the number and types of leukocytes present in a measured sample of blood. Overall the normal number of leukocytes ranges from 5000 to 10,000/mm3. . It was apparent to the ER doctor that she had appendicitis. He put in a surgical consult and made the obligatory order for a CT scan with oral and IV contrast. The CT scan was "negative." The surgeon then examined the patient and was bewildered; he ordered another CT scan, which was again "negative." After that, I examined the patient and then called the surgeon who told me that the CT scan was 97% predictive and that she was on antibiotics and if she were still symptomatic he would operate on her in the morning. The next morning he laparoscopically resected her suppurative suppurative pertaining to or emanating from suppuration; pus in e.g. suppurative arthritis, bronchopneumonia. appendix off of her anterior abdominal wall and left in a drain. Her length of stay was extended significantly. Our local surgeons are developing whole series of CT-negative acute appendicitis cases. For the life of me I cannot see how the CT scanner can replace the serial abdominal examination along with a white count and a sedimentation rate, etc. We are now training general surgeons not to rely on their own senses and common sense, but the herd mentality of the CT scanner which cannot replace good surgical judgment. Will somebody please tell the radiologist he has on no clothes? Robert M. Richey, MD Carolinas Hospital System Florence, SC |
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