Imaging Findings in Acute Abdomen

Part of the Medical Radiology book series (MEDRAD)


Multislice CT has evolved as the first-line imaging modality in patients with an acute abdomen. Multiple studies have shown that its utilization increases diagnostic accuracy and decreases morbidity and mortality. The imaging findings and the pathophysiological background of the most frequently encountered etiologies or life-threatening conditions are reviewed, including appendicitis, diverticulitis, bowel obstruction, bowel ischemia, and gastrointestinal perforation.


Bowel Wall Small Bowel Obstruction Compute Tomography Finding Crohn Disease Bowel Ischemia 


  1. Abou-Nukta F, Bakhos C, Ikekpeazu N, Ciardiello K (2005) Ruptured giant colonic diverticulum. Am Surg 71:1073–1074PubMedGoogle Scholar
  2. Abujudeh HH, Kaewlai R, McMahon PM, Binder W, Novelline RA, Scott Gazelle G, Thrall JH (2011) Abdominopelvic CT increases diagnostic certainty and guides management decisions: a prospective investigation of 584 patients in a large academic medical center. Am J Roentgenol 196:238–243CrossRefGoogle Scholar
  3. Andersson RE, Petzold MG (2007) Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg 246:741–748PubMedCrossRefGoogle Scholar
  4. Beattie GC, Peters RT, Guy S, Mendelson RM (2007) Computed tomography in the assessment of suspected large bowel obstruction. ANZ J Surg 77:160–165PubMedCrossRefGoogle Scholar
  5. Cappell MS, Batke M (2008) Mechanical obstruction of the small bowel and colon. Med Clin N Am 92:575–597PubMedCrossRefGoogle Scholar
  6. Cho HS, Yoon SE, Park SH, Kim H, Lee YH, Yoon KH (2009) Distinction between upper and lower gastrointestinal perforation: usefulness of periportal free air sign on computed tomography. Eur J Radiol 69:108–113PubMedCrossRefGoogle Scholar
  7. Choi JS, Lim JS, Kim H, Choi JY, Kim MJ, Kim NK, Kim KW (2008) Colonic pseudoobstruction: CT findings. Am J Roentgenol 190:1521–1526CrossRefGoogle Scholar
  8. D’Ambrosio N, Katz D, Hines J (2006) Perforated appendix within a femoral hernia. Am J Roentgenol 186:906–907CrossRefGoogle Scholar
  9. Daly CP, Cohan RH, Francis IR, Caoili EM, Ellis JH, Nan B (2005) Incidence of acute appendicitis in patients with equivocal CT findings. Am J Roentgenol 184:1813–1820Google Scholar
  10. Elsayes KM, Menias CO, Smullen TL, Platt JF (2007) Closed-loop small-bowel obstruction: diagnostic patterns by multidetector computed tomography. J Comput Assist Tomogr 31:697–701PubMedCrossRefGoogle Scholar
  11. Furukawa A, Kanasaki S, Kono N, Wakamiya M, Tanaka T, Takahashi M, Murata K (2009) CT diagnosis of acute mesenteric ischemia from various causes. Am J Roentgenol 192:408–416CrossRefGoogle Scholar
  12. Ghekiere O, Lesnik A, Hoa D, Laffargue G, Uriot C, Taourel P (2007) Value of computed tomography in the diagnosis of the cause of nontraumatic gastrointestinal tract perforation. J Comput Assist Tomogr 31:169–176PubMedCrossRefGoogle Scholar
  13. Gore RM, Miller FH, Pereles FS, Yaghmai V, Berlin JW (2000) Helical CT in the evaluation of the acute abdomen. Am J Roentgenol 174:901–913Google Scholar
  14. Horton KM, Fishman EK (2010) CT angiography of the mesenteric circulation. Radiol Clin N Am 48:331–345PubMedCrossRefGoogle Scholar
  15. Kaiser AM, Jiang JK, Lake JP, Ault G, Artinyan A, Gonzalez-Ruiz C, Essani R, Beart RW (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100:910–917PubMedCrossRefGoogle Scholar
  16. Kellow ZS, MacInnes M, Kurzencwyg D, Rawal S, Jaffer R, Kovacina B, Stein LA (2008) The role of abdominal radiography in the evaluation of the nontrauma emergency patient. Radiology 248:887–893PubMedCrossRefGoogle Scholar
  17. Keyzer C, Zalcman M, de Maertelaer V, Coppens E, Bali MA, Gevenois PA, van Gansbeke D (2005) Comparison of US and unenhanced multi-detector row CT in patients suspected of having acute appendicitis. Radiology 236:527–534PubMedCrossRefGoogle Scholar
  18. Laméris W, van Randen A, van Es HW, van Heesewijk JP, van Ramshorst B, Bouma WH, ten Hove W, van Leeuwen MS, van Keulen EM, Dijkgraaf MG, Bossuyt PM, Boermeester MA, Stoker J (2009) Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ 339:b2431CrossRefGoogle Scholar
  19. Langell JT, Mulvihill SJ (2008) Gastrointestinal perforation and the acute abdomen. Med Clin N Am 92:599–625PubMedCrossRefGoogle Scholar
  20. Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP (2011) National trends in CT use in the emergency department: 1995–2007. Radiology 258:164–173PubMedCrossRefGoogle Scholar
  21. Lazarus DE, Slywotsky C, Bennett GL, Megibow AJ, Macari M (2004) Frequency and relevance of the “small bowel feces” sign on CT in patients with small bowel obstruction. Am J Roentgenol 183:1361–1366Google Scholar
  22. Lee SY, Coughlin B, Wolfe JM, Polino J, Blank FS, Smithline HA (2006) Prospective comparison of helical CT of the abdomen and pelvis without and with oral contrast in assessing acute abdominal pain in adult emergency department patients. Emerg Radiol 12:150–157PubMedCrossRefGoogle Scholar
  23. Leschka S, Alkadhi H, Wildermuth S, Marincek B (2005) Multi-detector computed tomography of acute abdomen. Eur Radiol 15:2435–2447PubMedCrossRefGoogle Scholar
  24. Liu SI, Siewert B, Raptopoulos V, Hodin RA (2002) Factors associated with conversion to laparotomy in patients undergoing laparoscopic appendectomy. J Am Coll Surg 194:298–305PubMedCrossRefGoogle Scholar
  25. Marincek B (2002) Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies. Eur Radiol 12:2136–2150PubMedGoogle Scholar
  26. Martin LC, Merkle EM, Thompson WM (2006) Review of internal hernias: radiographic and clinical findings. Am J Roentgenol 186:703–717CrossRefGoogle Scholar
  27. Mazeh H, Epelboym I, Reinherz J, Greenstein AJ, Divino CM (2009) Tip appendicitis: clinical manifestations and management. Am J Surg 197:211–215PubMedCrossRefGoogle Scholar
  28. Menke J (2010) Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology 256:93–101PubMedCrossRefGoogle Scholar
  29. Ng SP, Cheng SM, Yang FS, Tzen CY, Huang JK (2007) Hyperdense appendix on unenhanced CT: a sign of acute appendicitis. Abdom Imaging 32:701–704CrossRefGoogle Scholar
  30. O’Connor CE, Reed WP (1994) In vivo location of the human vermiform appendix. Clin Anat 7:139–142CrossRefGoogle Scholar
  31. Oguro S, Funabiki T, Hosoda K, Inoue Y, Yamane T, Sato M, Kitano M, Jinzaki M (2010) 64-slice multidetector computed tomography evaluation of gastrointestinal tract perforation site: detectability of direct findings in upper and lower GI tract. Eur Radiol 20:1396–1403PubMedCrossRefGoogle Scholar
  32. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD (2004) Acute mesenteric ischemia: a clinical review. Arch Intern Med 164:1054–1062PubMedCrossRefGoogle Scholar
  33. Pedrosa I, Lafornara M, Pandharipande PV, Goldsmith JD, Rofsky NM (2009) Pregnant patients suspected of having acute appendicitis: effect of MR imaging on negative laparotomy rate and appendiceal perforation rate. Radiology 250:749–757PubMedCrossRefGoogle Scholar
  34. Petrovic B, Nikolaidis P, Hammond NA, Grant TH, Miller FH (2006) Identification of adhesions on CT in small-bowel obstruction. Emerg Radiol 12:88–93PubMedCrossRefGoogle Scholar
  35. Pickhardt PJ, Levy AD, Rohrmann CA, Kende AI (2002) Primary neoplasms of the appendix manifesting as acute appendicitis: CT findings with pathologic comparison. Radiology 224:775–781PubMedCrossRefGoogle Scholar
  36. Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C (2005) CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. Am J Roentgenol 185:406–417Google Scholar
  37. Raja AS, Wright C, Sodickson AD, Zane RD, Schiff GD, Hanson R, Baeyens PF, Khorasani R (2010) Negative appendectomy rate in the era of CT: an 18-year perspective. Radiology 256:460–465PubMedCrossRefGoogle Scholar
  38. Ros PR, Huprich JE (2006) ACR appropriateness criteria on suspected small-bowel obstruction. J Am Coll Radiol 3:838–841PubMedCrossRefGoogle Scholar
  39. Rosen MP, Sands DZ, Longmaid HE III, Reynolds KF, Wagner M, Raptopoulos V (2000) Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. Am J Roentgenol 174:1391–1396Google Scholar
  40. Rosenblat JM, Rozenblit AM, Wolf EL, DuBrow RA, Den EI, Levsky JM (2010) Findings of cecal volvulus at CT. Radiology 256:169–175PubMedCrossRefGoogle Scholar
  41. Shin LK, Halpern D, Weston SR, Meiner EM, Katz DS (2005) Prospective CT diagnosis of stump appendicitis. Am J Roentgenol 184:S62–S64Google Scholar
  42. Silen W (2010) Cope’s early diagnosis of the acute abdomen, 22nd edn. Oxford University Press, New YorkGoogle Scholar
  43. Silva AC, Pimenta M, Guimarães LS (2009) Small bowel obstruction: what to look for. RadioGraphics 29:423–439PubMedCrossRefGoogle Scholar
  44. Singh AK, Gervais DA, Hahn PF, Rhea J, Mueller PR (2004) CT appearance of acute appendagitis. Am J Roentgenol 183:1303–1307Google Scholar
  45. Stoker J, van Randen A, Laméris W, Boermeester MA (2009) Imaging patients with acute abdominal pain. Radiology 253:31–46PubMedCrossRefGoogle Scholar
  46. Stollman N, Raskin JB (2004) Diverticular disease of the colon. Lancet 363:631–639PubMedCrossRefGoogle Scholar
  47. Taourel P, Kessler N, Lesnik A, Pujol J, Morcos L, Bruel JM (2003) Helical CT of large bowel obstruction. Abdom Imaging 28:267–275PubMedCrossRefGoogle Scholar
  48. Tsuboi M, Takase K, Kaneda I, Ishibashi T, Yamada T, Kitami M, Higano S, Takahashi S (2008) Perforated and nonperforated appendicitis: defect in enhancing appendiceal wall-depiction with multi-detector row CT. Radiology 246:142–147PubMedGoogle Scholar
  49. Urban BA, Fishman EK (2000) Tailored helical CT evaluation of acute abdomen. RadioGraphics 20:725–749PubMedGoogle Scholar
  50. van Randen A, Laméris W, van ES HW, ten Hove W, Bouma WH, van Leeuwen MS, van Keulen EM, van der Hulst VP, Henneman OD, Bossyut PM, Boermeester MA, Stoker J (2010) Profiles of US and CT imaging features with a high probability of appendicitis. Eur Radiol 20:1657–1666Google Scholar
  51. Wiesner W, Khurana B, Ji H, Ros PR (2003) CT of acute bowel ischemia. Radiology 226:635–650PubMedCrossRefGoogle Scholar
  52. Wildermuth S, Leschka S, Alkadhi H, Marincek B (2005) Multislice CT in the pre- and postinterventional evaluation of mesenteric perfusion. Eur Radiol 15:1203–1210PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.University of ZurichKilchbergSwitzerland
  2. 2.Emergency RadiologyCase Western Reserve University, University Hospitals Case Medical CenterClevelandUSA

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