ABSTRACT

Objective: To evaluate the diagnostic utility of gas under the diaphragm on abdominal radiograph for patients with a perforated appendix.

Study Design: A prospective, observational study

Study Setting and Duration: General Surgery Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan was conducted between September 2018 to September 2020.

Methodology: All patients with suspected appendicitis, irrespective of gender were included in the study. Patients with age younger than 12 years or older than 60 years were excluded. All findings from the imagings were noted. The plain radiograph was looking for “Gas under diaphragm”. All imaging was performed by a radiologist with experience of five years or more. All data were entered into a statistical package for social sciences (SPSS version 24).

Results: The appendix diameter was highly significantly associated with the risk of perforation in patients with appendicitis (p<0.001). Similarly, the patients with a perforated appendix have a higher white blood cell count compared to those without perforation (15.6 ± 5.1 versus 13.2 ± 4.4; p-value = 0.002). It was found that out of the 76 patients with perforated appendicitis pneumoperitoneum was positive in 6 (7.8%) patients while out of those with a non-perforated appendix, 8 (10.5%) had gas under the diaphragm.

Conclusion: Gas under the diaphragm on a plain radiograph was detected in only a few cases with perforated appendicitis. Nevertheless, if positive, it warrants immediate abdominal surgery and requires comprehensive investigation.

Keywords: Abdominal Radiography, Appendicitis, Gas under Diaphragm, Perforated Appendicitis, Ruptured Appendicitis, Pneumoperitoneum, Tomography