Systematic Review: The Role of Intravenous and Oral Contrast in the Computed Tomography Evaluation of Acute Appendicitis

Zachary Soucy; David Cheng; Gary M Vilke; Richard Childers

doi:10.1016/j.jemermed.2019.10.034

Systematic Review: The Role of Intravenous and Oral Contrast in the Computed Tomography Evaluation of Acute Appendicitis

J Emerg Med. 2020 Jan;58(1):162-166. doi: 10.1016/j.jemermed.2019.10.034. Epub 2019 Dec 13.

Authors

Zachary Soucy¹, David Cheng², Gary M Vilke³, Richard Childers³

Affiliations

¹ Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
² Department of Emergency Medicine, Northeastern Ohio Medical Center, Rootstown, Ohio.
³ Department of Emergency Medicine, University of California, San Diego Health, San Diego, California.

PMID: 31843324
DOI: 10.1016/j.jemermed.2019.10.034

Abstract

Background: This systematic review provides practicing emergency physicians updated information regarding the role of oral and intravenous contrast in the computed tomography (CT) evaluation of acute appendicitis.

Methods: A PubMed literature search was conducted from January 1, 1996 to December 31, 2018 and limited to human clinical trials written in English with relevant keywords. High-quality studies were identified and then underwent a structured review. Recommendations are made based on the literature review.

Results: Fifty-seven articles met criteria for rigorous review, of which 14 were appropriate for citation in this review. Excellent evidence shows that oral contrast does not improve the test characteristics of CT with intravenous contrast (IVCT) in the evaluation of adults suspected of having acute appendicitis. Good evidence shows that noncontrast abdominal CTs have excellent test characteristics for this same group of patients.

Conclusions: Considering its downsides and lack of utility, the medical literature does not support using oral contrast in the evaluation of acute appendicitis. There is no direct evidence showing that IVCT is better than a noncontrast CT in the evaluation of acute appendicitis; however, the available literature is consistent with slightly better test characteristics for IVCTs. Still, if IVCT cannot be obtained in a timely manner, noncontrast CTs are extremely accurate in detecting this disease.

Keywords: CT; acute appendicitis; contrast.