Acute right lower quadrant pain beyond acute appendicitis: MDCT in evaluation of benign and malignant gastrointestinal causes

PurposeTo evaluate the role of MDCT in identification of various GIT pathologies beyond appendicitis that cause acute right lower quadrant abdominal pain and characterization of various distinguishing CT features as well as their predictive values in differentiating benign from malignant pathologies.Materials and methodsThis retrospective study included a total of 64 patients (34 females and 30 males with age ranges from 21 to 78 years) who presented with ARLQP (acute right lower quadrant pain). MDCT was done for all the patients; inclusion criteria included the presence of clinical, laboratory, and radiological evidence of the pathologic process. Pathological confirmation was obtained in 44 cases. All cases proved pathologically to be appendicitis were eventually excluded from the study cohort. Various CT morphologic parameters were recorded including the location of bowel wall involvement, the extent of involvement, the thickness of bowel wall and pattern of bowel wall thickening, the presence of stratified enhancement pattern, the transition from normal to abnormal wall, the degree of mesenteric fat stranding relative to the degree of wall thickening, the presence of excavating masses, and associated findings. A multivariate analysis was performed using covariates among the variable morphologic CT features.ResultsA stratified enhancement pattern of the bowel wall was the most reliable to indicate a benign active inflammatory process with the highest −ve predictive value of 91% and an abrupt zone of transition also proved to be the most significant in indicating a malignant process with a +ve PV of 74%.ConclusionUsing a systematic pattern approach MDCT has proved to be an extremely useful noninvasive method for evaluation of patients with acute RLQP, allowing diagnosis and management of not only the most common conditions such as appendicitis but also less common conditions.