The barium enema in appendicitis

The urgent use of the barium enema in the diagnosis of appendicitis is useful in patients with an atypical clinical presentation. The classic findings of nonfilling of the appendix associated with a pericecal inflammatory mass provide valuable support for the diagnosis of appendiceal inflammation. The barium enema may also demonstrate a variety of other abnormalities that are less well recognized. These include the demonstration of an inflammatory mass lateral or medial to the ascending colon, or deep in the pelvis with maximal involvement of the rectum or sigmoid. In some patients, the cecum itself is normal and the inflammatory mass is remote from the usual location of the appendix. Nonfilling of the appendix and an associated extrinsic mass involving the cecum are not specific for appendiceal inflammation; they may also be seen in a variety of other entities including tubo-ovarian abscess, other gyncologic masses, enterocolitis and small bowel obstruction. In spite of these occasional pitfalls, the use of the barium enema in patients with a nonspecific clinical presentation is quick, easy, safe and rewarding.