Endoscopic Retrograde Appendicography: An Alternative Diagnostic Method for Acute Appendicitis

Zhenzhen Liu,1 Xiao Ma,2 Saif Ullah,1 Jitao Song,2 Lingjian Kong,1 Deliang Li,1 Chao Pan,2 Bingrong Liu1 1Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 2Department of Gastroenterology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of ChinaCorrespondence: Bingrong LiuDepartment of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, People’s Republic of ChinaTel/Fax +86-15713815559Email fccliubr@zzu.edu.cnPurpose: To evaluate the role of endoscopic retrograde appendicography for the diagnosis of acute appendicitis.Patients and Methods: We retrospectively analyzed 33 patients (20 men and 13 women, average age 44± 18 years) with suspected acute appendicitis between December 2016 and November 2018. Endoscopic direct-vision imaging or fluoroscopic endoscopic retrograde appendicography was performed to separate suspected acute appendicitis from actual acute appendicitis. The success rate, complications, and recurrence rate were recorded.Results: Acute appendicitis was ruled out by normal endoscopic retrograde appendicography in 8 (24%) and confirmed in 23 patients (70%). In 2 patients (6%), appendiceal orifice cannulation failed. Colonoscopic findings in acute appendicitis were mucosal hyperemia and edema of appendiceal orifice (83%), outpouring of pus from the appendiceal orifice (74%), and swollen cecal mucosa (61%). Appendicograpic findings were either normal or in acute disease showed diffuse luminal dilation (diameter: 0.8± 0.4 mm), partial stenosis (43%), stiffness or inflexibility (87%) and filling defects (22%). There were no complications during or after follow-up for a median of 13 months (IQR: 9– 24 months).Conclusion: Endoscopic retrograde appendicography appears to be a reliable and safe method to confirm or exclude the diagnosis of acute appendicitis and prevent unnecessary appendectomy.Keywords: acute appendicitis, endoscopic retrograde appendicography, diagnosis, appendicography