The utility of urgent abdominal computed tomography in the elderly patient

Abstract

The purpose of this study was to assess the utility of urgent abdominal computed tomography (CT) performed in a nontrauma setting on a predominantly elderly population. We retrospectively reviewed abdominal CT images of 170 patients (average age, 64 years); CT was performed on a “stat” basis to evaluate suspected acute abdominal pathology at a typical urban Veterans’ Affairs hospital. Imaging results were correlated with subsequent clinical intervention.

Abdominal CT was most commonly ordered to assess abdominal pain (119 cases, 71%), suspected abdominal abscess (11 cases, 6.5%), suspected leaking abdominal aortic aneurysm (11 cases, 6.5%), and suspected acute pancreatitis (8 cases, 5%). Clinically relevant findings were recorded in 96 abdominal CT cases (56%), only 23 (13.5%) of which depicted acute pathology. This included nine patients with abscesses, four with diverticulitis, two with nonspecific enteric inflammation, and two with cholecystitis. Only 16 patients (9%) required urgent therapy. The most common clinically relevant findings not requiring prompt intervention were cholelithiasis (11 cases), chronic pancreatitis (9 cases), and liver metastases (6 cases). Of 13 patients with abdominal aortic aneurysm diagnosed on abdominal CT, 11 presented with abdominal pain, but none showed signs of rupture. Although, in a predominantly elderly population, urgent abdominal CT often reveals significant chronic disease, it seldom depicts pathology requiring prompt therapy. Therefore, a more focused use of this examination is warranted.