Use of the barium swallow in the diagnosis of acute appendicitis.

A simplified radiographic procedure was utilized in children with suspected acute appendicitis in an effort to improve diagnostic accuracy. Children with suspected appendicitis were given 6 oz of barium by mouth, and follow-up posteroanterior, and oblique radiographs of the abdomen were obtained 6 to 12 hours after barium ingestion. Appendicitis was not seen in 63 children with complete appendiceal filling. An 8 percent incidence of appendicitis was seen with partial appendiceal filling. A 42 percent incidence of appendicitis was noted in 110 children with nonvisualization of the appendix, and an 86 percent incidence of appendicitis was noted where there was a mass effect on the cecum. The advantages and disadvantages of the barium swallow have been discussed. By utilizing the barium swallow as a diagnostic adjunct, an overall 95 percent accuracy rate in the diagnosis of acute appendicitis was achieved over a 4 1/2 year period.