DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161761

Results of emergency management of acute abdomen in adults based on clinical assessment and basic imaging investigations: are advanced imaging techniques always necessary for successful treatment?

Sangram Karandikar

Abstract


Background:The term acute abdomen refers to signs and symptoms of abdominal pain and tenderness, a clinical presentation that may require emergency surgical treatment. Patients suffering from both, surgical as well as medical diseases may present with acute abdomen. The main objectives of the study are to identify common causes of acute abdomen, to assess the need for urgent surgical intervention in these patients and to evaluate role of basic diagnostic techniques and need of advanced imaging studies.

Methods: Forty patients with acute onset abdominal pain were included in the study. Patients with pain related to pregnancy, trauma and pediatric age group were excluded from the study. All patients were subjected to detailed history and clinical examination, X-ray abdomen in erect position and ultrasound examination of the abdomen and pelvis. CECT of abdomen and pelvis was performed only when there were diagnostic difficulties and for deciding about need for surgical intervention.

Results: Out of 40, fifteen (37.5%) patients required surgery within 24 hours and 14 (35%) patients underwent elective surgery after emergency treatment. Eleven (27.5%) patients were managed conservatively.

Conclusion: Study shows that the commonest causes for acute abdomen are acute appendicitis and cholelithiasis with /without cholecystitis. Almost 1/3rd of the patients required emergency surgery. And CECT of abdomen and pelvis was helpful in decision making between conservative and surgical management of acute abdomen in selected cases.


Keywords


Acute abdomen, Emergency laparotomy, Negative findings at laparotomy, Diagnostic difficulty, Criteria for exploratory laparotomy

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References


Nagle A. Acute Abdominal Pain, ACS Surgery: Principles and Practice. 2009;3(2):1-17.

Kavanagh S. The acute abdomen - assessment, diagnosis and pitfalls. UK MPS Casebook. 2004;12(1):11-7.

Gupta K, Bhandari R, Chander R. Comparative study of plain abdomen and ultrasound in non-traumatic acute abdomen. Indian Journal Radiological Imaging. 2005;15:109-15.

Thomson H, Jones P. Active observation in acute abdominal pain. Am J Surg. 1986;152(5):522-5.

van Randen A, Laméris W, Luitse JS, Gorzeman M, Hesselink EJ, Dolmans DE, et al. The role of plain radiographs in patients with acute abdominal pain at the ED. Am J Emerg Med. 2011;29(6):582-9.

Allemann F, Cassina P, Röthlin M, Largiader F. Ultrasound scans done by surgeons for patients with acute abdominal pain: a prospective study. Eur J Surg. 1999;165(10):966-70.

Nega B. Pattern of acute abdomen and variables associated with adverse outcome in a rural primary hospital setting. Ethiop Med J. 2009;47(2):143-51.

Hwang H, Marsh I, Doyle J. Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Canadian J Surg. 2014;57(3):162-8.

Kellow ZS, MacInnes M, Kurzencwyg D, Rawal S, Jaffer R, Kovacina B, et al. The role of abdominal radiography in the evaluation of the non trauma emergency patient. Radiology. 2008;248(3):887-93.

Rao P, Rhea J, Rao J, Conn A. Plain abdominal radiography in clinically suspected appendicitis: diagnostic yield, resource use, and comparison with CT. Am J Emerg Med. 1999;17(4):325-8.

Anyanwu A, Moalypour S. Are abdominal radiographs still overutilized in the assessment of acute abdominal pain? A district general hospital audit. J R Coll Surg Edinb. 1998;43(4):267-70.

Eray O, Cubuk MS, Oktay C, Yilmaz S, Cete Y, Ersoy FF. The efficacy of urinalysis, plain films, and spiral CT in ED patients with suspected renal colic. Am J Emerg Med. 2003;21(2):152-4.

Puylaert J. Acute appendicitis: USG evaluation using graded compression. Radiology. 1986;158(2):355-60.

Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med. 1994;154(22):2573-81.

Haroun AA, Hadidy AM, Mithqal AM, Mahafza WS, Al-Riyalat NT, Sheikh-Ali RF. The role of B-mode ultrasonography in the detection of urolithiasis in patients with acute renal colic. Saudi J Kidney Dis Transpl. 2010;21(3):488-93.

Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Br J Surg. 2014;101(1):e109-18.