The role of US examination in the management of acute abdomen

Radiologic Clinics of North America, 2003

Multislice, helical CT is increasingly replacing ultrasonography (US) for the evaluation of patients with acute abdominal pain [1 -3]. CT has major advantages over US: it is extremely fast and its time burden is often less than that of a US examination [4]. CT is not disturbed by gas and bone, and obesity is even an advantage. Most of all, CT is not operatordependent and can be reviewed by others, even at a distance.

American Journal of Roentgenology, 1994

An acute abdomen is a clinical condition characterized by severe abdominal pain that develops suddenly over several hours or less [1]. Abdominal tenderness and rigidity, either generalized or localized, usually are severe and indicate an urgent need for prompt diagnosis and treatment. The underlying cause of acute abdomen varies, and some cases require immediate surgical treatment, whereas for others, surgery is unnecessary or contraindicated. This need for prompt diagno

Seminars in Ultrasound, CT and MRI, 1999

Currently, CT plays a pivotal role in the evaluation of the patient with an acute abdomen. Several competing techniques have been described and investigated. Each appears to possess advantages and disadvantages which will be examined. Each imaging center needs to modify these protocols to satisfy local scanner availability, patient demographics, radiologic expertise, and economic considerations.

American Journal of Roentgenology, 1997

The purpose of this study was to evaluate the effect of CT on the diagnosis and management of acute abdominal pain in patients who did not undergo surgery and to determine what population of patients would profit most from CT examination. MATERIALS AND METHODS. Clinical data and CT reports of 91 patients with acute abdomen (4 1 men and 50 women. 22-96 years old) were analyzed retrospectively. The accuracies

Journal of Biomedical Graphics and Computing, 2014

Acute abdomen can be defined as a clinical condition often requires emergency surgical therapy and characterized by severe abdominal pain with tenderness that develops over a short period of time, generally less than 24 hours. There are a variety of conditions that can present clinically with acute abdomen such as: inflammatory, vascular, mechanic, traumatic. In many cases, the clinical presentation is similar, independent of etiology. The radiological imaging plays very important role to determine the need for operative intervention and initiate appropriate therapy. Our aim is to describe the computed tomography findings of the most common conditions of acute abdomen excluding trauma and pediatric or obstetric patients.

International Journal of Contemporary Medicine, Surgery and Radiology, 2018

Back ground: Of all patients presenting to the Emergency Department(ED), approximately 10% have complaints of acute abdominal pain. Non-traumatic acute abdominal pain is one of the most common symptoms in adults presenting to the emergency department. Clinical assessment is sufficient to decide on the level of urgency, but not on the specific cause of the acute abdominal pain. The causes of abdominal pain vary from life threatening to the self-limiting. Management decision on the basis of clinical and laboratory tests alone can result in unnecessary intervention or delayed management. Hence a diagnostic modality has to be formulated which aids in clinical diagnosis and prevents mortalities. CT scan and ultrasound now become principal investigation in non-traumatic acute abdomen. This study aims to correlate the usefulness of USG abdomen and CT abdomen in patients presenting with acute abdominal pain in emergency department. Materials and Methods:  The present study of computed tomography and ultrasound evaluation of non-traumatic acute abdomen was a prospective study of 100 patients using ultra sound and CT scan modality. The present study is carried out at department of radiology, Guru Gobind Singh Hospital and M P Shah Medical College, Jamnagar. The study was carried out between 2017 to 2019.  Results were checked by two radiologists (PI and CO-PI) and final comparative data wasprepared from Computed Tomography (CT) and Ultrasound study. Results:  Out of 100 patients in this study, 65 % were male and 35% were female. Youngest patient was 11nonth-old female baby and oldest patient was 100-year-old female, majority of the patients were adults with highest number of them in the age group of 30-40 years (20 %), among our patients 100 patients (29%) showed changes of pancreatitis (13 %) showed appendicitis and small bowel obstruction other common conditions encountered were cholecystitis (13 %) and renal ureteric calculi (8%), USG abdomen was abnormal in 55.17% of the pancreatitis and 76% of patients with appendicitis and small bowel obstruction and 81% in patients with cholecystitis and 87% in patients with renal or ureteric calculi. Conclusion: In the present series of study conducted for correlation of CECT abdomen and USG abdomen in the evaluation of acute non-traumatic abdomen, CECT abdomen was more sensitive and accurate in diagnosing the causes of non-traumatic acute abdomen, although USG abdomen was proved to be valuable first hand tool in management of non-traumatic acute abdomen.

Internal and Emergency Medicine, 2008

Our aim was to assess the effects of initial ultrasonography (US) evaluation on the diagnosis and management of non-traumatic acute abdominal pain in the emergency department. Three hundred patients with the complaint of non-traumatic acute abdominal pain who were sent for US examination with an initial clinical impression were included in the study. Pre-US and post-US surveys were designed for the clinicians who requested US. The percentage concordance of US findings with the discharge diagnosis made by clinical follow-up, imaging modalities and surgery was determined by calculating the confidence interval. The concordance of the initial clinical impression and the US diagnosis with the discharge diagnosis were compared using the McNemar test. US could not detect any pathology in 102 (34%; 95%CI, 28.6-39.3%) of the patients. The US revealed a different diagnosis than the clinical impression in 69 (23%; 95%CI, 18.2-27.7%), and confirmed the diagnosis in 121 (40%; 95%CI, 34.4-45.5%) patients. The US changed the treatment plans in 47% (95%CI, 41.3-52.6%) of the patients. The clinicians stated US helped them ''very much'' or ''moderately'' in making a diagnosis in 83% (95%CI, 78.7-87.2%). When US results were compared with the discharge diagnosis, there was concordance in 238 (79.3%; 95%CI, 74.3-83.6%) patients but not in 62 (20.6%; 95%CI, 16-25.1%). Among 121 patients the initial clinical impression agreed with the US diagnosis and there was concordance with the discharge diagnosis in 105 (86.7%; 95%CI, 80-92.7%). The concordance of US findings with the discharge diagnosis was significantly higher than that of the initial clinical impression statistically. In the initial evaluation of the patients with acute abdominal pain, US is considerably helpful in making the correct diagnosis, and that the concordance with the discharge diagnosis is high. When whole abdominal scanning is not performed, targeted US study according to the initial clinical impression decreases the clinical benefit of US.

Seminars in Ultrasound, CT and MRI, 1995

The diagnostic workup of the acute abdomen always begins with a precise clinical history, a complete physical examination, and careful reading of plain films. Commonly performed additional imaging studies include contrast examination and, more recently, ultrasound. CT offers the advantage of allowing a comprehensive diagnostic evaluation of both solid and hollow viscera in neoplastic as well as in inflammatory and vascular disorders.

Objective: To evaluate the accuracy and impact of early computerized tomography (CT) in the diagnosis of non-traumatic acute abdomen when Ultrasonogram (USG) or X-ray findings are negative, equivocal or unable to provide additional information regarding the diagnosis. Materials and methods: 126 patients were included in this prospective study. Ultrasonogram was done as the initial modality in these patients and CT was done when USG findings were negative, equivocal or unable to provide additional information. Axial, coronal and sagittal reformatted images were studied. When appropriate, MIP and volume rendering techniques were also analysed. IV, oral and rectal contrast were used depending upon the clinical condition. All the 126 patients were followed up and diagnoses obtained before and after CT were compared with per-operative findings or final diagnosis at discharge. Results: Among 126 patients, correct diagnosis could be obtained in 125 patients. The initial planned management was changed in 18 patients; 13 patients who were initially planned for surgery were managed, conservatively and 5 patients who were initially placed on conservative management were operated upon. Thus unnecessary surgery was avoided in 13 patients and much needed emergency surgery performed on 5 patients based on CT findings. Conclusion : Early CT abdomen done in patients presenting with non-traumatic acute abdominal pain helps in arriving at an accurate diagnosis and planning the appropriate treatment, thus reducing the morbidity and mortality.