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Acute Abdominal Pain: Diagnostic Impact of Immediate CT Scanning

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Abstract

Background

Acute abdominal pain is a common diagnostic problem. This study aimed to evaluate the routinely use of contrast enhanced computed tomographic (CT) scanning early in the diagnostic process.

Methods

A retrospective review of 2,222 patients with acute abdominal pain who underwent contrast enhanced CT scanning within 24 h after admission. The diagnoses obtained were compared with the final diagnoses after 1 month.

Results

After CT scanning the following diagnoses were suggested as the primary cause of the abdominal pain: nonspecific abdominal pain 984 (44.3%), appendicitis 354 (15.9%), bowel obstruction 190 (8.6%), diverticulitis 182 (8.2%), gastrointestinal perforation 52 (2.3%), gallstone disease 64 (2.9%), pancreatitis 72 (3.2%), inflammatory bowel disease 13 (0.6%), intra-abdominal malignancy 34 (1.5%), vascular disease (including 1 completely cured patient with paradoxical embolization in the superior mesenteric artery) 33 (1.5%), urological 131 (5.9%), gynecological 54 (2.4%), miscellaneous 31 (1.4%). In 28 cases a conclusive CT examination could not be carried out. The suggested diagnoses were correct in 2,151 cases (96.8%). In 16 cases (0.7%) an incorrect diagnosis was reported, leading to 7 unnecessary laparotomies. False negative reports were obtained in 27 cases (1.2%). After CT examination 500 patients could be discharged immediately.

Conclusions

Contrast-enhanced CT scanning results in superior diagnostic precision in patients with acute abdominal pain. The present work supports the strategy to include this examination early in the routine diagnostic process.

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References

  1. Fenyö G, Boijsen M, Enochsson L, et al. (2000) Acute abdomen calls for considerable care resources. Analysis of 3,727 in-patients in Stockholm County in the first quarter of 1995. Läkartidningen 97:4008–4012

    PubMed  Google Scholar 

  2. Silen W (2005) Cope’s Early Diagnosis of the Acute Abdomen, 21st Edition. New York, Oxford University Press

    Google Scholar 

  3. Martin RF, Rossi RL (1997) The acute abdomen. An overview and algorithms. Surg Clin North Am 77:1227–1243

    Article  PubMed  CAS  Google Scholar 

  4. Andersson RE, Hugander AP, Ghazi SH, et al. (2000) Why does the clinical diagnosis fail in suspected appendicitis? Eur J Surg 166:796–802

    Article  PubMed  CAS  Google Scholar 

  5. Tepel J, Sommerfeld A, Klomp H-J, et al. (2004) Prospective evaluation of diagnostic modalities in suspected acute appendicitis. Langenbecks Arch Surg 389:219–224

    Article  PubMed  Google Scholar 

  6. Gore RM, Miller FH, Pereles FS, et al. (2000) Helical CT in the evaluation of the acute abdomen. AJR Am J Roentgenol 174:901–913

    PubMed  CAS  Google Scholar 

  7. Ng CS, Watson CJE, Palmer CR, et al. (2002) Evaluation of early abdominopelvic computed tomography inpatients with acute abdominal pain of unknown cause: prospective randomised study. BMJ 325:1387–1389

    Article  PubMed  Google Scholar 

  8. Rosen MP, Siewert B, Sands DZ, et al. (2003) Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 13:418–424

    PubMed  Google Scholar 

  9. Salem TA, Molloy RG, O’Dwyer PJ (2005) Prospective study on the role of the CT scan in patients with an acute abdomen. Colorectal Dis 7:460–466

    Article  PubMed  CAS  Google Scholar 

  10. Johnson CD, Baker ME, Rice RP, et al. (1987) Diagnosis of acute colonic diverticulitis: comparison of barium enema and CT. AJR Am J Roentgenol 148:541–546

    PubMed  CAS  Google Scholar 

  11. Stapakis JC, Thickman D (1992) Diagnosis of pneumoperitoneum: abdominal CT vs upright chest film. J Comput Assist Tomogr 16:713–716

    Article  PubMed  CAS  Google Scholar 

  12. Taourel PG, Deneuville M, Pradel JA, et al. (1996) Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology 199:632–636

    PubMed  CAS  Google Scholar 

  13. Dalzell DP, Scharling ES, Ott DJ, et al. (1998) Acute pancreatitis: the role of diagnostic imaging. Crit Rev Diagn Imaging 39:339–363

    PubMed  CAS  Google Scholar 

  14. Rao PM, Rhea JT, Novelline RA, et al. (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 338:141–146

    Article  PubMed  CAS  Google Scholar 

  15. Burkill GJC, Bell JRG, Healy JC (2001) The utility of computed tomography in acute small bowel obstruction. Clin Radiol 56:350–359

    Article  PubMed  CAS  Google Scholar 

  16. Khurana B, Ledbetter S, McTavish J, et al. (2002) Bowel obstruction revealed by multidetector CT. AJR Am J Roentgenol 178:1139–1144

    PubMed  Google Scholar 

  17. Delabrousse E, Destrumelle N, Brunelle S, et al. (2003) CT of small bowel obstruction in adults. Abdom Imaging 28:257–266

    Article  PubMed  CAS  Google Scholar 

  18. Taourel P, Kessler N, Lesnik A, et al. (2003) Helical CT of large bowel obstruction. Abdom Imaging 28:267–275

    Article  PubMed  CAS  Google Scholar 

  19. Kaiser S, Finnbogason T, Jorulf HK, et al. (2004) Suspected appendicitis in children: diagnosis with contrast-enhanced versus nonenhanced helical CT. Radiology 231:293–295

    Article  Google Scholar 

  20. Rhea JT, Halpern EF, Ptak T, et al. (2005) The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients. AJR Am J Roentgenol 184:1802–1808

    PubMed  Google Scholar 

  21. United Nations Scientific Committee on the Effects of Atomic Radiation (2000) Sources and Effects of Ionizing Radiation. New York, United Nations

  22. Berrington de González A, Darby S (2004) Risk of cancer from diagnostic x-rays: estimates for the UK and 14 other countries. Lancet 363:345–351

    Article  Google Scholar 

  23. Laurell H, Hansson L-E, Gunnarsson U (2006) Acute abdominal pain in a defined population—the impact of the formal competence of the physician and the use of structured schedule for investigation. In Laurell H, Acute Abdominal Pain (PhD dissertation), Uppsala University, Uppsala, Sweden

  24. Velanovich V, Satava R (1992) Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance. Am Surg 58:264–269

    PubMed  CAS  Google Scholar 

  25. Calder JDF, Gajraj H (1995) Recent advances in the diagnosis and treatment of acute appendicitis. Br J Hosp Med 54:129–133

    PubMed  CAS  Google Scholar 

  26. Fenyö G, Lindberg G, Blind P, et al. (1997) Diagnostic decision support in suspected acute appendicitis: validation of a simplified scoring system. Eur J Surg 163:831–838

    PubMed  Google Scholar 

  27. Laurell H, Hansson L-E, Gunnarsson U (2006) Manifestations of acute appendicitis—a prospective study on acute abdominal pain. In Laurell H, Acute Abdominal Pain (PhD Dissertation). Uppsala, Sweden, Uppsala University

  28. Laurell H, Hansson L-E, Gunnarsson U (2006) Acute abdominal pain among elderly patients. Gerontology 52:339–344

    Article  PubMed  CAS  Google Scholar 

  29. Boey J, Wong J (1987) Perforated duodenal ulcers. World J Surg 11:319–324

    Article  PubMed  CAS  Google Scholar 

  30. Blomgren LGM (1997) Perforated peptic ulcer: long-term results after simple closure in the elderly. World J Surg 21:412–415

    Article  PubMed  CAS  Google Scholar 

  31. Gore RM, Yaghmai V, Newmark GM, et al. (2002) Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 40:1307–1323

    Article  PubMed  Google Scholar 

  32. Acosta S, Björck M (2003) Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population. Eur J Vasc Endovasc Surg 26:179–183

    Article  PubMed  CAS  Google Scholar 

  33. Schoots IG, Koffeman GI, Legemate DA, et al. (2004) Systematic review of survival after acute mesenteric ischemia according to disease aetiology. Br J Surg 91:17–27

    Article  PubMed  CAS  Google Scholar 

  34. Acosta S, Ögren M, Sternby N-H, et al. (2004) Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery—a population-based study. Eur J Vasc Endovasc Surg 27:145–150

    Article  PubMed  CAS  Google Scholar 

  35. Moore EM, Endean ED (2005) Treatment of acute intestinal ischemia caused by arterial occlusions. In Rutherford RB, editor, Vascular Surgery, 6th Edition, Philadelphia, Elsevier-Saunders, 1718–1728

    Google Scholar 

  36. Johansson G, Swedenborg J (1986) Ruptured abdominal aortic aneurysms: a study of incidence and mortality. Br J Surg 73:101–103

    Article  PubMed  CAS  Google Scholar 

  37. Hinchliffe RJ, Bruijstens L, MacSweeney STR, et al. (2006) A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysm—results of a pilot study and lessons learned for future studies. Eur J Vasc Endovasc Surg 32:506–513

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors acknowledge with gratitude Dr. Jon Ahlberg, former Head of the Department of Surgery, and Dr. Magnus Boijsen, Section of Emergency Surgery, who introduced and implemented the policy of early CT scanning detailed in the present report.

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Authors and Affiliations

  1. Department of Surgery, Karolinska University Hospital at Huddinge and Capio St.Göran’s Hospital, SE-141 86, Stockholm, Sweden

    Cecilia Strömberg

  2. Department of Surgery, Capio St.Göran’s Hospital and Capio Diagnostics, SE-112 81, Stockholm, Sweden

    Cecilia Strömberg & Gunnar Johansson

  3. Department of Radiology, Capio Diagnostic, SE-112 81, Stockholm, Sweden

    Anders Adolfsson

Authors
  1. Cecilia Strömberg
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  2. Gunnar Johansson
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  3. Anders Adolfsson
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Corresponding author

Correspondence to Cecilia Strömberg.

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Strömberg, C., Johansson, G. & Adolfsson, A. Acute Abdominal Pain: Diagnostic Impact of Immediate CT Scanning. World J Surg 31, 2347–2354 (2007). https://doi.org/10.1007/s00268-007-9233-x

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  • DOI: https://doi.org/10.1007/s00268-007-9233-x

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