Imaging of non-traumatic abdominal emergencies in adults

Abstract

Non-traumatic abdominal pathology is one of the most common reasons for consultation in emergency care services. Abdominal pain is the presenting symptom for many diseases, which often requires urgent care. Clinical history and physical examination are rarely sufficient to establish a definite diagnosis and imaging is usually necessary. The choice of imaging modality is oriented by the clinical context and guided by the institutional capabilities, safety and cost-effectiveness of the available tests. Plain radiographs have little or no place in the evaluation of the acute abdomen. Magnetic resonance imaging (MRI) still has limited availability in many hospitals, thus narrowing the imaging choice to ultrasound (US) and computerized tomography (CT). No scientific evidence exists to allow the imposition of one single strategy. At the present time, the clinician may choose either routine US evaluation complemented by CT in case the US is inconclusive or first-line CT (except for the evaluation of right lower quadrant [RLQ] pain, right upper quadrant [RUQ] pain and in pregnant women where ultrasound is the first-line study).

Reducing length of stay for patients presenting to general surgery with acute non‐surgical abdominal pain

“…Previous studies have shown increases in the use of additional imaging, mainly CT scan, to aid diagnosis for patients presenting with acute non-traumatic abdominal pain. 3,5,6 Although the diagnostic accuracy is increased, 9,14 a recent study has shown that routine imaging leads to significantly increased waiting times and costs. 1 Therefore, initiatives like 'Choosing Wisely' and pathways using selective imaging have been introduced.…”

“…[1][2][3][4] The use of computed tomography (CT) scans to aid early diagnosis for patients presenting with acute abdominal pain has also increased over the last decade. 3,5,6 This increase has been associated with an increase in the proportion of scans that are negative for acute pathology. 3 Also, this diagnostic tool comes with significant downsides, including radiation exposure, increased waiting times, costs and carries risk of contrast-induced allergy.…”

“…The use of computed tomography (CT) scans to aid early diagnosis for patients presenting with acute abdominal pain has also increased over the last decade 3,5,6 . This increase has been associated with an increase in the proportion of scans that are negative for acute pathology 3 .…”

Acil Radyolojide Goruntuleme Protokolleri

“…Nontravmatik abdominal acillerde ilk tercih olan direkt abdominal grafiler, ayakta ve yatar pozisyonda çekilmekte olup intraabdominal patolojileri saptamadaki düşük duyarlılıkları nedeniyle büyük ölçüde rutin klinikte yerini diğer görüntüleme yöntemlerine bırakmıştır. Direkt grafiler yardımıyla mekanik intestinal obstrüksiyon ya da perforasyonu düşündürecek intraabdominal serbest hava tespit edilmesi durumunda dahi etyolojinin ve obstruksiyon ya da perforasyonun lokalizasyonunun belirlenebilmesi için ileri görüntülemeye başvurulması gerekmektedir [36]. İntestinal obstrüksiyon varlığında tercih edilmesi gereken görüntüleme yöntemi BT'dir.…”

Predicting cannulation difficulty in endoscopic retrograde cholangiopancreatography using CT image findings: a decision-tree analysis

“…The advantages of CT are lower cost, shorter scan time, and wider differential diagnostic considerations, which is useful in patients who present with unusual symptoms or signs (7). In addition, various anatomic structures can be analyzed accurately through a two- or three-dimensional (3D) reconstruction without increasing the radiation dose (8). For this reason, CT is widely performed before ERCP in clinical settings.…”