[size=20px]An abdominal computerized tomography (CT) scan is obtained in a six year old boy after a motor vehicle crash. The scan is normal except for an incidental appendicolith with no radiographic signs of acute appendicitis. The child has no symptoms to suggest appendicitis.

 

The most appropriate management of this patient with an incidentally discovered appendicolith is

 

A immediate appendectomy.

 

B elective appendectomy.

 

C admission for observation.

 

D follow-up CT scan.

 

E instructions to return if symptomatic.[/size]

E

E

correct

 

In a patient with an acute abdomen the presence of an appendicolith virtually mandates treatment for acute appendicitis. However, an incidental appendicolith without evidence of appendicitis may be identified on computerized tomography (CT) scan in 0.4 to 13% of the general population. Studies in adults suggest that the risk of appendicitis is actually quite low. In a retrospective review of 2913 children with pelvic CT scans, isolated appendicoliths were identified in 2.6%. Such children also appear to be at low risk for developing appendicitis. Given the recognized risks of ionizing radiation and the observation that appendicoliths are often a transient finding, one cannot justify the case for follow-up imaging in the absence of symptoms.

(Untitled)

 

E