Evaluation of the utility of abdominal CT scans in the diagnosis, management, outcome and information given at discharge of patients with non-traumatic acute abdominal pain

Chin, Jen; Goldstraw, Emma; Lunniss, Peter J.; Patel, Kumkum

doi:10.1259/bjr/95400367

Cited by 20 publications

(14 citation statements)

References 15 publications

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“…The reported cases discuss a variety of imaging modalities used to diagnose caecal volvulus such as: plain film abdominal radiographs, gastrografin enema (diagnostic accuracy of 4%–50% and 90%, respectively) and abdominal CT 25 26. However, in current practice, the role of contrast enema and plain film abdominal radiographs is questionable in the context of such patients due to the increased sensitivity of CT imaging to detect additional pathology and superior diagnostic sensitivity in excess of 90% for caecal volvulus 27–29. In this example, the most likely predisposing risk factors were: female gender, age, prior abdominal surgery and ileus caused by elective surgery.…”

Section: Discussionmentioning

confidence: 99%

Caecal volvulus following left-side laparoscopic retroperitoneal nephroureterectomy

et al. 2019

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Caecal volvulus is an uncommon cause of intestinal obstruction, with a high associated morbidity and mortality. Caecal volvulus is a very rare complication following retroperitoneal surgery. As such, a high degree of clinical suspicion is warranted post operatively to minimise delay in definitively investigating and managing this condition. We present a case of an 80-year-old Caucasian woman who was admitted for an elective left-sided laparoscopic retroperitoneal nephroureterectomy for transitional cell carcinoma of the left upper pole renal calyx. Postoperatively, the patient developed intestinal obstruction, secondary to caecal volvulus. The patient underwent an emergency laparotomy and limited right-sided colonic resection with primary anastomosis.

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Section: Discussionmentioning

confidence: 99%

Caecal volvulus following left-side laparoscopic retroperitoneal nephroureterectomy

et al. 2019

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“…Plain abdominal films obtained during an episode of SBO may show dilated jejunal loops clustered toward the upper abdomen, but they do not help in pointing to the etiology. CT has emerged as the gold standard for a fast and accurate preoperative diagnosis, making the condition amenable to laparoscopic management . A left PDH has a characteristic CT appearance with clustering of bowel loops, a sac‐like mass with encapsulation at the ligament of Treitz, depression of the duodeno‐jejunal junction, and engorgement, crowding, or displacement of the mesentery vessels (Figure ).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic repair of left paraduodenal hernia: Report of two cases and review of the literature

Kulkarni

Salgaonkar

Sharma

et al. 2016

Asian J Endoscop Surgery

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Internal hernia is the cause of only 1% of intestinal obstructions, and left paraduodenal hernias (PDH) comprise about 50% of these cases. As the presentation of PDH is varied, diagnosis is often delayed. Here, we report two patients with left PDH presenting in a subacute manner and diagnosed rapidly with the help of a CT scan. Both underwent successful laparoscopic repair; one patient had closure of the defect, and the other required excision of the sac prior to the closure. We review 21 cases of left PDH treated laparoscopically that were previously reported in the literature, including 14 from Asian countries.

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“… 10 Ultrasound, as well as CT scans, have been established as important imaging techniques in an evaluation of the acute abdomen. 11 , 12 More use of imaging in our setting may prevent trivial admissions.…”

Section: Discussionmentioning

confidence: 99%

Consequences of peritonism in an emergency department setting

Bjørsum-Meyer

Schmidt

2013

OAEM

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BackgroundIn patients who were referred to the emergency department (ED) with abdominal pain, it is crucial to determine the presence of peritonism to allow for appropriate handling and subsequent referral to stationary departments. We aimed to assess the incidence of perceived peritonism in a contemporary ED and to make a comparable characterization on specified endpoints, including hospital stay, performed acute surgery, and ordered imaging.MethodsA single-center study was performed during 2010 in a contemporary Danish ED. We evaluated 1,270 patients consecutively admitted to the ED and focused on the patients with abdominal pain. Following a physical examination, the patients with abdominal pain were divided into those who had clinical signs of peritonism and those who did not.ResultsAmong the 1,270 patients admitted to the ED, 10% had abdominal pain. In addition, 41% of these patients were found to have signs indicative of peritonism, and 90% were admitted to the Department of Surgery (DS). Also, 24% of those patients with signs of peritonism and admission to the DS underwent surgical intervention in terms of laparotomy/laparoscopy. Five of the patients without peritonism underwent surgery. The patients perceived to have peritonism were younger at 34±3.0 years (mean ± standard error of the mean) than the patients who were not perceived to have peritonism, 52±2.8 years (P<0.05). They also had a shorter length of stay of 38.2±6.0 hours at the DS versus 95.3±18.2 hours (P<0.05). No differences with statistical significance were found regarding a stay in the emergency room (ER) or ordered imaging from the ER.ConclusionPeritonism was a common finding in our setting. Peritonism did not require more acute surgery or imaging. The duration of the patient’s stay in the ER was not influenced by a finding of peritonism. The evaluation of peritonism needs to be improved in the ED.

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Evaluation of the utility of abdominal CT scans in the diagnosis, management, outcome and information given at discharge of patients with non-traumatic acute abdominal pain

Cited by 20 publications

References 15 publications

Caecal volvulus following left-side laparoscopic retroperitoneal nephroureterectomy

Caecal volvulus following left-side laparoscopic retroperitoneal nephroureterectomy

Laparoscopic repair of left paraduodenal hernia: Report of two cases and review of the literature

Consequences of peritonism in an emergency department setting

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