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文献考察1)：穿孔性虫垂炎は虫垂内糞石，体温38℃以上，下痢，腹膜刺激症状，CRPの上昇が有意に高い．
急性虫垂炎の臨床的検討 とくに穿孔性虫垂炎の診断について
Author：横山義信(木戸病院), 齊藤智裕, 山田明, 阿部要一, 塚田一博
Source：日本腹部救急医学会雑誌(1340-2242)21巻8号 Page1369-1374(2001.11)
Abstract：過去6年間における急性虫垂炎199例中,穿孔例64症例(男43例・女21例,平均43.4±23.9歳)を中心に穿孔性虫垂炎の診断について検討した.穿孔例は,非穿孔例138例(男81例・女54例,平均29.1±17.1歳)と比較して平均年齢が有意に高く,特に65歳以上の高齢者の穿孔率は61.1%と非穿孔例に比べ有意に高率であった.穿孔例では虫垂内糞石の存在が高率(52.4%)で,腋窩温上昇(38℃以上),下痢,腹膜刺激症状陽性,CRP値の上昇が有意に高く,診断には超音波検査が有用であった.以上の結果から65歳以上の高齢者症例で38℃以上の発熱があり,下痢,腹膜刺激症状が認められる場合には穿孔性虫垂炎を考慮し,早急にCRPの測定や超音波検査を行い,診断・治療する必要がある.特に虫垂内糞石が存在する場合には穿孔率が高いので,早急に手術を行う必要があると考えられた．
文献考察２）：CT活用でnegative appendectomy は３％
AJR Am J Roentgenol. 2005 Jun;184(6):1802-8.
The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients.
Rhea JT, Halpern EF, Ptak T, Lawrason JN, Sacknoff R, Novelline RA.
OBJECTIVE: Appendiceal CT was introduced at our hospital in 1996 and now is used in most patients. The use of appendiceal CT has generated controversy and mixed results in various investigations. Our purpose was to determine the percentage of patients for whom CT was performed, incidence of appendicitis, accuracy of CT, percentage of equivocal interpretations, and negative appendectomy rates for those patients who did and did not undergo CT. MATERIALS AND METHODS: Patient records from 2001 that included clinical or CT preoperative examination were analyzed, with follow-up through 2003. Patient age and sex, clinical presentation, CT techniques, CT interpretations, operative reports, pathology reports, and patient disposition were determined. Final diagnoses were provided by pathologic criteria, patient follow-up, or patient survey. Statistical analysis included Fisher's exact test and receiver operating characteristic (ROC) curves. RESULTS: Of 753 patients, 663 (88%) were examined on CT for suspected appendicitis and 90 had an appendectomy without undergoing CT. The incidence of appendicitis in the patients who underwent CT was 39.2%. The sensitivity and specificity of CT were 99% and 95%, respectively; the area under the ROC curve was 0.9896; and the percentage of equivocal CT interpretations was 3.3%. The false-negative appendectomy rates were 3.0% and 5.6% for patients with and without CT, respectively (for all patients, p = 0.326; for female pediatric patients, p = 0.030). CONCLUSION: Five years ago, the negative appendectomy rate dropped from 20% to 7%, and it is now 3.0%. The incidence of appendicitis in patients who are examined on CT is stable compared with similar cohorts from prior investigations. Patients who do not undergo CT also have a low negative appendectomy rate, but this relatively small group is selected on the basis of a convincing clinical presentation. Female pediatric patients likely would have a lower negative appendectomy rate with greater use of CT.PMID: 15908534
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