WTP4.05 Should we CT young women with acute RIF pain?

Aims Many premenopausal women present acutely with right iliac fossa pain. The differentials are broad and include appendicitis and other surgical, gynaecological, urological, and psychological conditions. These women are twice as likely as men to undergo negative diagnostic laparoscopies for possible appendicitis. Our aims are to establish Is the rate of negative diagnostic laparoscopy significantly different in young women that underwent no imaging, ultrasound or CT? Depending on the above, should young women have cross-sectional imaging before diagnostic laparoscopy despite the risks? Methods We conducted a retrospective search for women aged 16-55 who presented over two years to a tertiary referral centre with acute right iliac fossa pain and underwent a diagnostic laparoscopy. Our primary outcomes were whether they had ultrasound or CT and the outcome of the surgery (positive or negative for appendicitis). We chased histology results to confirm the appendicitis. Results A total of 504 women were found of whom 375 had imaging. Of those imaged, more had CT scans (n=229) than ultrasound (n=146). Almost all the scans occurred before diagnostic laparoscopy. Twenty percent (n=102) did not have appendicitis. More people who had no scan (n=27) or ultrasound (n=58) ended up having negative laparoscopy compared to those who had CT (n=17). Conclusions The decision to image young women with right iliac fossa pain is multifactorial and there are no specific guidelines. However, exposing young women to the radiation of cross-sectional imaging should be considered if it reduces the rate and risks of unnecessary diagnostic laparoscopies.