Fallacy of the Roentgenologically Negative Appendix

To the Editor:—  During roentgenologic consultations regarding colon studies, clinicians frequently either inquire specifically if an appendix filled with barium or state in effect that an opacified appendix may be assumed to be normal. Several facets of appendiceal anatomy and pathology invalidate such emphasis upon appendiceal opacification: (1) Appendiceal length varies enormously. Unless the precise length of an appendix is known, it cannot be regarded as opacified in its entirety. (2) Appendicitis is rarely caused by luminal obstruction at the appendiceal base, precluding the entrance of barium.

Report of Cases:—  Case 1.—A 67-year-old man with a history of chronic dysuria and nocturia was hospitalized for a prostatectomy after the onset of anuria. The patient complained of nausea, vomiting and abdominal cramps. Physical examination revealed abdominal distention with right lower quadrant tenderness, in addition to prostatic enlargement.A preoperative excretory pyelogram disclosed an incomplete small intestine obstruction, but no urinary tract