To the Editor.—I read with interest the article by Fee et al (Arch Surg 112:742-744, 1977) and fear it may discourage a useful diagnostic procedure.
Referring to this article, Fig 1 is a beautiful example of a "short" appendix and a "cut-off" sign virtually pathognomonic of appendicitis. I do not agree with the caption, which states it is normal. I agree that Fig 2 does appear normal. Figure 3 is difficult to analyze, but might have a foreshortened appendix or a nonopaque filling defect within it. Some of the difficulty here could be due to the use of a soluble contrast agent. We always recommend barium.
The results on the three patients in the study are interesting, but I question the interpretations. Also, three patients is hardly a "series." How often was a barium enema study utilized with beneficial results?
Actually, we are trying to answer that question with