Evaluation of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause: prospective randomised study

Ng, Chaan S.; Watson, Christopher J.; Palmer, C.; See, Teik Choon; Beharry, N.; Housden, B.A.; Bradley, J. Andrew; Dixon, Adrian K.

doi:10.1136/bmj.325.7377.1387

Cited by 147 publications

(94 citation statements)

References 12 publications

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“…High accuracy of CT has been reported for appendicitis and for acute diverticulitis (98%) [3,4]. A study evaluating the diagnostic value of abdominal CT in patients with acute abdominal pain in general also showed good results, with an accuracy of 78% for CT, including clinical evaluation [5]. Although the accuracy reported in the literature is good, this does not automatically imply that reproducibility is good as well and that accuracy results reported in the literature can be generalised to the local clinical situation.…”

Section: Introductionmentioning

confidence: 87%

Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain

et al. 2009

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The level of inter-observer agreement of abdominal computed tomography (CT) in unselected patients presenting with acute abdominal pain at the Emergency Department (ED) was evaluated. Two hundred consecutive patients with acute abdominal pain were prospectively included. Multi-slice CT was performed in all patients with intravenous contrast medium only. Three radiologists independently read all CT examinations. They recorded specific radiological features and a final diagnosis on a case record form. We calculated the proportion of agreement and kappa values, for overall, urgent and frequently occurring diagnoses. The mean age of the evaluated patients was 46 years (range 19-94), of which 54% were women. Overall agreement on diagnoses was good, with a median kappa of 0.66. Kappa values for specific urgent diagnoses were excellent, with median kappa values of 0.84, 0.90 and 0.81, for appendicitis, diverticulitis and bowel obstruction, respectively. Abdominal CT has good inter-observer agreement in unselected patients with acute abdominal pain at the ED, with excellent agreement for specific urgent diagnoses as diverticulitis and appendicitis.

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Section: Introductionmentioning

confidence: 87%

Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain

et al. 2009

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“…However, clinical examination has been found to be only accurate in 47-76% of patients with acute abdominal pain. [1][2][3][4] Even the most experienced surgeon will make correct diagnosis in only 4 out of 5 cases. This drops to 50% with junior doctors and doctors working in the community.…”

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confidence: 99%

Prospective Study on the Role of C-Reactive Protein (CRP) in Patients with an Acute Abdomen

Molloy

O’Dwyer

2007

annals

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INTRODUCTION C-reactive protein (CRP) is used routinely in many hospitals to evaluate patients with an acute abdomen. We assessed CRP levels in non-specific abdominal pain (NSAP) and surgical conditions requiring operative or non-operative intervention. The aim of this study was to identify a level of CRP that can be useful in differentiating these three groups.PATIENTS AND METHODS All patients older than 25 years and admitted with acute abdominal pain other than those requiring emergency surgery were included. CRP within 24 h was assessed in all patients. Various cut-off values (< 6, > 6-50, > 50-100, > 100-150 and > 150 mg/l) were used to identify a useful diagnostic level of CRP in the 3 groups. RESULTS A total of 211 patients were prospectively evaluated -129 women and 82 men with a mean age of 62.4 years (range, 27-92 years). CRP was performed in 196 within 24 h of admission. Sixty had NSAP while 136 had a surgical condition, of whom 69 had an operation/intervention while the rest were treated non-operatively. The median and interquartile (IQ) range for the three groups were: NSAP, 16 mg/l and 7.75-85.75 mg/l; surgical non-operative group, 75 mg/l and 30.5-150 mg/l; and surgical-operative, 111 mg/l and 42-212 mg/l, respectively. These results were statistically significant (P = 0.001). NSAP was diagnosed in 61% of patients at levels < 6 mg/l compared to 39% of patients in the surgical groups. At levels > 150 mg/l, NSAP was diagnosed in 15% of patients compared to only 54% and 31% for the operative and non-operative groups, respectively. CONCLUSIONS Despite statistically significant differences between the three groups, no useful level of CRP could be identified to differentiate between patients with NSAP and those requiring operative or non-operative management. KEYWORDSC-reactive protein -CRP -Acute abdomen -Accuracy

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“…Radiological imaging prior to and after insufflation of air into the stomach through a nasogastric tube (pneumo-gastrography), can be used for the diagnosis or confirmation of upper gastrointestinal visceral perforation (8). Although plain chest and abdomen X-ray are common investigation tools in the diagnosis of even small amounts of intra-abdominal air, abdominal CT is more sensitive for identification of pneumoperitoneum and differential diagnosis of acute abdomen (9,10).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous idiopathic pneumoperitoneum with acute abdomen

İflazoğlu

Gökçe

Kıvrak

et al. 2015

UCD

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Pneumoperitoneum is often caused by visceral perforation, and usually manifests with symptoms of peritonitis requiring surgical intervention. Non-surgical spontaneous pneumoperitoneum (ie. not associated with organ perforation) is a rare entity due to intrathoracic, intra-abdominal, gynecologic, iatrogenic or other reasons, and is usually treated conservatively. Idiopathic spontaneous pneumoperitoneum is even rarer than visceral perforation or other causes of free intra-abdominal air. In this report, we present a case of idiopathic spontaneous pneumoperitoneum. A seventy-five-year-old female patient presented with acute abdominal pain, low-grade fever, and nausea. Her abdominal examination findings were vague, and she did not have leukocytosis. Free intra-abdominal air was detected on plain X-ray, she was followed-up with cessation of oral intake, nasogastric tube, fluid resuscitation and prophylactic antibiotics for one day. There were no signs of acute abdomen except diffuse abdominal tenderness by deep palpation on the first day examination. There was a mild leukocytosis with a shift to the left in leukocytes, and pneumoperitoneum on abdominal X-ray. The abdominal computed tomography revealed free intra-abdominal air and minimal free fluid in Douglas pouch. Her past medical history revealed cholecystectomy (10 years ago) with no chronic diseases, regular medications, smoking, or alcohol consumption. The patient underwent emergency laparotomy. Despite lack of an identifiable cause and uncertainty of etiology, the patient was discharged on postoperative day 5. A thorough medical history, appropriate laboratory tests and radiological techniques and physical examination should be combined for identification of patients with non-surgical pneumoperitoneum, and avoid unnecessary laparotomy, while minimally invasive techniques such as laparoscopy should be considered as part of evaluation.

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Evaluation of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause: prospective randomised study

Cited by 147 publications

References 12 publications

Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain

Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain

Prospective Study on the Role of C-Reactive Protein (CRP) in Patients with an Acute Abdomen

Spontaneous idiopathic pneumoperitoneum with acute abdomen

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