Tip appendicitis: clinical implications and management. Am J Surg

Department of General Surgery, Hadassash-Hebrew University Medical Center, Jerusalem, Israel.
American journal of surgery (Impact Factor: 2.29). 10/2008; 197(2):211-5. DOI: 10.1016/j.amjsurg.2008.04.016
Source: PubMed


Tip appendicitis describes a rare condition involving inflammatory changes of the distal appendix. We discuss the significance and management of this entity when it is identified on computed tomography (CT) imaging.
CT scans performed at our institution between 2003 and 2007 were reviewed to identify cases of tip appendicitis. Patients were divided into 2 groups, determined by the confirmation of appendicitis on histopathology. Radiological findings and the clinical courses of both groups were documented and compared using univariate analysis.
Of 18 patients with the CT finding of tip appendicitis, appendicitis was ultimately confirmed in 39%. Patients in this group had a higher rate of right lower quadrant (RLQ) tenderness (100% vs 55%, P = .04), leukocytosis (14.2 vs 10.5, P = .03), and clinical suspicion for acute appendicitis (43% vs 0%, P = .02). There were no complications or re-admissions.
The CT finding of tip appendicitis can be managed conservatively in a subset of patients with low clinical suspicion for acute appendicitis.

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    • "Appendiceal obstruction leading to appendicitis can occur anywhere along the appendix [15, 24]. Therefore, if only a small part of the appendix is involved, the inflammation may be limited to the tip [43]. Incomplete visualisation of the whole length of the appendix due to position can lead to a false-negative result if only the tip of the appendix is involved. "
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