Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2016; 8(9): 651-655
Published online Sep 27, 2016. doi: 10.4240/wjgs.v8.i9.651
Barium appendicitis: A single institution review in Japan
Hideki Katagiri, Alan Kawarai Lefor, Tadao Kubota, Ken Mizokami
Hideki Katagiri, Tadao Kubota, Ken Mizokami, Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu city, Chiba 279-0001, Japan
Alan Kawarai Lefor, Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan
Author contributions: Katagiri H and Lefor AK were major contributors in writing manuscript; Katagiri H, Kubota T and Mizokami K collected and analyzed the data, and designed this study; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Tokyo Bay Urayasu Ichikawa Medical Center Institutional Review Board.
Informed consent statement: Written informed consent was obtained from the patients whose images are used in this study for publication of this study and accompanying images.
Conflict-of-interest statement: All authors declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hideki Katagiri, MD, Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu city, Chiba 279-0001, Japan. x62h20k38@yahoo.co.jp
Telephone: +81-047-3513101 Fax: +81-047-3526237
Received: April 25, 2016
Peer-review started: April 26, 2016
First decision: June 16, 2016
Revised: July 8, 2016
Accepted: July 20, 2016
Article in press: July 22, 2016
Published online: September 27, 2016
Abstract
AIM

To review clinical experience with barium appendicitis at a single institution.

METHODS

A retrospective review of patients admitted with a diagnosis of acute appendicitis, from January 1, 2013 to December 31, 2015 was performed. Age, gender, computed tomography (CT) scan findings if available, past history of barium studies, pathology, and the presence of perforation or the development of complications were reviewed. If the CT scan revealed high density material in the appendix, the maximum CT scan radiodensity of the material is measured in Hounsfield units (HU). Barium appendicitis is defined as: (1) patients diagnosed with acute appendicitis; (2) the patient has a history of a prior barium study; and (3) the CT scan shows high density material in the appendix. Patients who meet all three criteria are considered to have barium appendicitis.

RESULTS

In total, 396 patients were admitted with the diagnosis of acute appendicitis in the study period. Of these, 12 patients (3.0%) met the definition of barium appendicitis. Of these 12 patients, the median CT scan radiodensity of material in the appendix was 10000.8 HU, ranging from 3066 to 23423 HU (± 6288.2). In contrast, the median CT scan radiodensity of fecaliths in the appendix, excluding patients with barium appendicitis, was 393.1 HU, ranging from 98 to 2151 HU (± 382.0). The CT scan radiodensity of material in the appendices of patients with barium appendicitis was significantly higher than in patients with nonbarium fecaliths (P < 0.01).

CONCLUSION

Barium appendicitis is not rare in Japan. Measurement of the CT scan radiodensity of material in the appendix may differentiate barium appendicitis from routine appendicitis.

Keywords: Acute appendicitis, Barium appendicitis, Barium sulfate, Upper gastrointestinal imaging, Gastric cancer screening

Core tip: This is a retrospective study to review clinical experience with barium appendicitis at a single institution in Japan. In the three years of study period, 12 patients (3.0%) were diagnosed as barium appendicitis among 396 patients with acute appendicitis. The computed tomography (CT) scan radiodensity of material in the appendices of patients with barium appendicitis was significantly higher than in patients with nonbarium fecaliths. Barium appendicitis is not rare in Japan. Measurement of the CT scan radiodensity of material in the appendix may differentiate barium appendicitis from routine appendicitis.