A NEW retrospective analysis suggests that the presence of an appendicolith, alongside specific CT imaging features, can help clinicians identify patients at higher risk of complicated acute appendicitis.
The study analysed data from 331 patients who underwent surgery for acute appendicitis at the affiliated hospital of Qingdao University between 2016 and 2023. Researchers aimed to clarify the debated role of appendicoliths in predicting complicated disease and to identify imaging markers that may aid early risk stratification.
Appendicoliths Linked to Higher Risk of Complications
Of the 331 patients included, 179 had appendicoliths identified on CT imaging. Among these patients, 106 were diagnosed with complicated appendicitis, compared with 73 cases of uncomplicated disease. In contrast, among the 152 patients without appendicoliths, only 44 had complicated appendicitis, while 108 had uncomplicated disease.
Multivariable analysis showed that the presence of an appendicolith was independently associated with complicated appendicitis, with an odds ratio of 1.88. This finding supports the view that appendicoliths are not merely incidental findings but may play a clinically meaningful role in disease severity.
Key CT Indicators in Appendicolith-Associated Appendicitis
Further subgroup analysis focused on patients with appendicolith-associated appendicitis to identify imaging features linked to complications. Three CT findings emerged as independent predictors of complicated disease.
An increased appendiceal diameter was associated with higher risk, with each incremental increase raising the odds of complicated appendicitis. Moderate to severe periappendiceal fat stranding showed a particularly strong association, increasing the odds more than 17-fold. The presence of periappendiceal air was also a significant marker, indicating a substantially higher likelihood of complicated disease.
Interestingly, the size, number, and location of appendicoliths themselves were less predictive than these surrounding CT features, highlighting the importance of evaluating the broader inflammatory context on imaging.
Implications for Clinical Decision-Making
The findings suggest that appendicoliths, when combined with specific CT features, may help distinguish patients with complicated appendicitis who may benefit from prompt surgical intervention. Appendiceal diameter, fat stranding severity, and periappendiceal air could serve as practical imaging markers to guide treatment decisions.
The authors conclude that careful interpretation of CT findings in patients with appendicoliths may improve early identification of complicated appendicitis and support more tailored management strategies in acute care settings.
