A 25-year-old woman with an Alvarado score of 7 has an equivocal CT abdomen showing mild pericecal fat stranding without a visible appendix. What is the most appropriate next step?

• A MRI abdomen (no radiation, high sensitivity) ✓
• B Diagnostic laparoscopy
• C Repeat CT after 6 hours with oral contrast
• D Appendectomy without further imaging

Explanation

MRI abdomen is the preferred next investigation for suspected appendicitis when CT is equivocal, particularly in women of reproductive age (to exclude gynecological pathology such as ovarian torsion, ectopic pregnancy) and to avoid radiation. MRI has sensitivity of 94–97% and specificity of 96–99% for appendicitis. Avoiding ionizing radiation is especially important in young women. Diagnostic laparoscopy is appropriate after imaging when clinical suspicion remains high or as definitive management, but imaging clarification is preferable first in equivocal cases.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.