DOI: http://dx.doi.org/10.18203/2349-2902.isj20190549

Comparative analysis of clinical, radiological and operative findings in acute abdomen

Mir Zeeshan Ali, Vamsee Krishna Maddu

Abstract


Background: The term acute abdomen refers to signs and symptoms of abdominal pain and tenderness that often requires emergency surgical therapy. The objective of the present study is to compare pre-operative diagnosis based on clinical examination with the operative diagnosis in acute abdomen.

Methods: Total 60 cases of acute abdomen who underwent laparotomy in a tertiary care hospital   were analysed prospectively regarding clinical features and also assessed the diagnostic utility of radiological investigations like plain abdominal radiographs, ultrasonography and computed tomography.

Results: Acute abdomen was most common in males and 2nd to 5th decade of life. Appendicitis was most common cause of acute abdomen followed by hollow viscus perforation and intestinal obstruction. Abdominal pain was the most common symptom. Tenderness was the most common sign. Diagnostic utility of x-ray is more in hollow viscus perforation and intestinal obstruction, whereas ultrasonography is diagnostic in 64.3%. Ultrasonography accurately diagnosed acute appendicitis in 74.2%, hollow viscus perforation in 50%, and intestinal obstruction in 60% of patients. 95% clinical accuracy was found when compared to intra operative diagnosis. Kappa is 0.912 (p<0.0001).

Conclusions: Clinical judgement is key to diagnosis of acute abdomen and investigations are only supplementary and cannot replace the clinical decision.


Keywords


Acute abdomen, Acute appendicitis, Hollow viscua perforation, Intestinal obstruction, Laparotomy

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References


Elhardello OA, MacFie J. Digital rectal examination in patients with acute abdominal pain. Emerg Med J. 2018 Sep;35(9):579-80.

Verki MM, Motamed H. Rectus muscle hematoma as a rare differential diagnosis of acute abdomen; a case report. Emergency. 2018;6(1):e28.

Kaushal-Deep SM, Anees A, Khan S, Khan MA, Lodhi M. Primary cecal pathologies presenting as acute abdomen and critical appraisal of their current management strategies in emergency settings with review of literature. Int J Crit Illness Injury Sci. 2018 Apr 1;8(2):90.

Baker SR. The abdominal plain film. What will be its role in the future?. Radiologic Clin North Am. 1993 Nov;31(6):1335-44.

Sabiston DC Jr. and Lyerly KM. Text book of Surgery. The biologic basis of modern surgical practice. 15th ed. Harcourt Asia PTE Ltd: Saunders; 1997.

Scoutt LM, Sawyers SR, Bokhari J, Hamper UM. Ultrasound evaluation of the acute abdomen. Ultrasound Clin. 2007 Jul 1;2(3):493-523.

Puylaert JB. Ultrasonography of the acute abdomen: gastrointestinal conditions. Radiol Clin. 2003 Nov 1;41(6):1227-42.

Memon AA, Bhutto AA, Shaikh GS, Jokhio A, Soomro QA. Spectrum of diseases in patients with non-traumatic acute abdomen. J Liaquat Uni Med Health Sci. 2008 Sep;7(3):180-3.

Laal M, Mardanloo A. Acute Abdomen&59; Pre and Post-Laparotomy Diagnosis. Int J Collaborative Res Internal Med Public Health. 2009 Jan 1;1(5):157-65.

Matin MA, Siddiq AK, Hasan MM. Acute abdomen in a peripheral military hospital. J Armed Forces Med College Bangladesh. 2009 Dec;5(2):36-9.

Chhetri RK, Shrestha ML. A comparative study of pre-operative with operative diagnosis in acute abdomen. Kathmanolu university Med J 2005 Jun;3(2):107-10.

Paduszyńska K, Celnik A, Pomorski L. Patients subject to surgery due to acute abdominal disorders during the period between 2001-2004. Polish J Surg. 2012 Dec 1;84(10):488-94.

Squires R, Postier RG; Acute Abdomen. In: Townsend C, Beauchamp R D, Evers BM, Mattrox K, editors. Sabiston Textbook of Surgery. 19th ed. Saunders Elsevier; 2012.

Danse EM, Kartheuser A, Paterson HM, Laterre PF. Color Doppler sonography of small bowel wall changes in 21 consecutive cases of acute mesenteric ischemia. JBR-BTR. 2009;92(4):202-6.

Arora B, Gupta A, Nandi S, Sarwal A, Goyal P, Gogna S, et al. Comparative analysis of clinical, radiological and operative findings in acute abdomen. Int J Enhanced Res Med Dental Care. 2015;2(1):1590-2349.