IV contrast CT in suspected appendicitis

Is oral and IV contrast necessary in CT for the evaluation of children with suspected appendicitis? 

CT for appendicitis requires IV contrast to detect inflammation due to appendicitis or various other causes, but oral contrast is not necessary for the diagnosis of appendicitis. There is an increasing body of evidence that shows that there is no diagnostic compromise in those children who undergo CT without oral contrast for suspected appendicitis. In fact, diagnostic performance of CT without oral contrast has been found to be equivalent or better compared to CT with oral contrast. There is a high percentage of patients that do take oral contrast for whom the contrast does not even reach the point of interest, the terminal ileum, prior to the CT. In addition, delayed diagnostic evaluation, frequency of emesis after contrast bolus, and the need for a nasogastric tube to tolerate the bolus all limit the efficacy of oral contrast for CT. 

Sources

Anderson BA, Salem L, Flum DR: A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults. Am J Surg 2005;190:474-478. 

Laituri, Fraser JD, Aguayo P, et al: The lack of efficacy for oral contrast in the diagnosis of appendicitis by computed tomography. J Surg Res 2011;170:100-103.

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