A large study reveals CT findings that predict complicated acute appendicitis, which may influence treatment choices.

• Wider appendiceal diameter and wall enhancement defects correlate with a higher risk of complications (p < 0.001).
• In patients without an appendicolith, wall enhancement defects show an odds ratio of 3.39 for complications.

Surgeons should consider these imaging markers to better assess which patients may require surgical intervention versus conservative management.