The role of abdominal radiography in the diagnosis of acute appendicitis: Is it important?

Aim: Most of the patients presenting to the emergency department with an preliminary diagnosis of acute appendicitis (AA) are undergoing standing plain abdominal radiography (SPAR), but SPAR's contribution to the diagnosis of AA is being questioned today. The aim of our study is to evaluate the importance of SPAR in the diagnosis of AA to elucidate this controversial issue. Material and Methods: We evaluated preoperative SPAR findings and pathology results of patients who were operated with the diagnosis of AA between 2014 and 2017 at General Surgery Department of Ordu University Training and Research Hospital. The relationship between the presence/absence of the SPAR findings and the diagnosis of AA were analyzed. Results: 140 (77.8%) of 180 patients who were operated for suspicion of AA underwent SPAR. Of the 105 patients with SPAR findings, 90 (85.7%) had AA and 15 (14.3%) were no. No findings were found in the 35 of patients who underwent SPAR, 25 (71.4%) had AA and 10 (28.6%) did not. There was no statistically significant difference in the diagnosis of AA in patients with and without SPAR findings (p = 0.098). Of the 140 patients undergoing SPAR, 115 (82.1%) had AA, and 25 (17.9%) were no. Of the 40 patients without SPAR, 27 (67.5%) had AA and 13 (32.5%) did not. Whether or not SPAR was performed did not affect the diagnosis of AA (p = 0.07). Conclusion: SPAR rarely helps in diagnosis of AA. SPAR should not be routinely taken to every patient considered AA. If there is another cause of acute abdomen other than AA as a pre-diagnosis in the physician's mind, SPAR may be taken because it is cheap, accessible and easily interpretable