Multimodality approach for imaging of non-traumatic acute abdominal emergencies

Abstract

"Acute abdomen" includes spectrum of medical and surgical conditions ranging from a less severe to life-threatening conditions in a patient presenting with severe abdominal pain that develops over a period of hours. Accurate and rapid diagnosis of these conditions helps in reducing related complications. Clinical assessment is often difficult due to availability of over-the-counter analgesics, leading to less specific physical findings. The key clinical decision is to determine whether surgical intervention is required. Laboratory and conventional radiographic findings are often non-specific. Thus, cross-sectional imaging plays a pivotal role for helping direct management of acute abdomen. Computed tomography is the primary imaging modality used for these cases due to fast image acquisition, although US is more specific for conditions such as acute cholecystitis. Magnetic resonance imaging or ultrasound is very helpful in patients who are particularly sensitive to radiation exposure, such as pregnant women and pediatric patients. In addition, MRI is an excellent problem-solving modality in certain conditions such as assessment for choledocholithiasis in patients with right upper quadrant pain. In this review, we discuss a multimodality approach for the usual causes of non-traumatic acute abdomen including acute appendicitis, diverticulitis, cholecystitis, and small bowel obstruction. A brief review of other relatively less frequent but important causes of acute abdomen, such as perforated viscus and bowel ischemia, is also included.

Non-traumatic abdominal pain: assessment of diagnostic value of MDCT enterography in small bowel diseases—a retrospective study

“…The diagnosis was confirmed by obtaining operative data in 2 cases (100%). In contrast to Gangadhar et al, who stated that intestinal ischemia is the second most common cause of bowel-related non-traumatic abdominal pain coming in order of frequency after IBD [15]. In our study, only 2 cases (4%) of the total population were diagnosed as having bowel ischemia.…”

“…Proximal dilatation involving the stomach and the second part of the duodenum is noted. This is agreeing with Gangadhar et al who stated that acute aorto-mesenteric angle of less than 25°and attenuated aorto-mesenteric distance of less than 10 mm at the level of the third part of the duodenum are the main diagnostic criteria of SMA syndrome along with proximal bowel dilatation [15].…”

Abdominal Computed Tomography in the Emergency Room: Overuse of Medical Technologies and the Depreciation of Clinical Diagnosis

“…Of the total, 108 (12.9%) CT scans with normal results were found and 231 (27.7%) were considered unspecific for AAP, which is lower than the frequency reported in the literature 14 The analysis was directed to diagnoses of NSAP, OU and AP, which together account for more than 70% of the final diagnoses. As broadly reported in other studies, the CT showed a high degree of accuracy [1][2][3][4][5] , with a moderate correlation between clinical, post-CT and final diagnoses for NSAP and OU and excellent for AP. However, patients with a final and tomographic diagnosis of NSAP, OU and AP already showed clinical suspicion in more than 50% of the cases, reaching more than 90% for patients with AP, and thus, can be considered clinically unnecessary.…”

Opioid analgesic use among patients presenting with acute abdominal pain and factors associated with surgical diagnoses

“…However, if these initial investigations do not provide a diagnosis, it is clear that some patients (e.g. retroperitoneal perforation, or those unable to stand for an erect abdominal radiograph because of pain) will require more advanced imaging, such as CT, ultrasound, or MRI …”

“…retroperitoneal perforation, or those unable to stand for an erect abdominal radiograph because of pain) will require more advanced imaging, such as CT, ultrasound, or MRI. 20,21…”