The added value of multidetector CT in the diagnosis of gastrointestinal causes of acute abdomen in geriatrics

Abstract

Background Due to changes in the gastrointestinal system in geriatric people, there are higher rates of atypical presentations of common disorders. In order to decrease the mortality rate, an efficient and correct diagnosis should be given for these patients. The aim of this study was to assess the role of MDCT in evaluating gastrointestinal tract-related acute abdominal pain in geriatric patients. Results Among fifty geriatric patients presented clinically with acute abdominal pain of gastrointestinal origin from November 2019 to September 2020, mean age was 70.2 ± 5.6 years ranging from 65 to 86 years. Majority were female, (thirty patients, 60%). Gastric causes (16%): obstruction (62.5%) and perforation (37.5%); and intestinal causes (84%): obstruction (71.4%), inflammatory (28.6%), perforation (23.8%), vascular (11.9%), and others (2.4%) were the frequent causes of acute abdominal pain in the studied patients. MDCT had a very high sensitivity of 98% (95% CI) as well as its PPV (95% CI) was 100% in the evaluation of gastrointestinal-related acute abdominal pain. Conclusion MDCT is a reliable diagnostic imaging modality for geriatric patients presented with acute abdominal pain suggested to be of gastrointestinal origin with a very high sensitivity in diagnosing the causative pathological conditions. MDCT can efficiently differentiate between obstructive, inflammatory, perforated, and ischemic bowel disorders.

Multidetector Computed Tomography in Diagnosis of Mesenteric Vascular ‎Occlusion

“…Our results were supported by study of Emara et.al in 2018 [20] as they revealed that their study was carried out on 30 patients with clinically suspected mesenteric vascular occlusion. According to their clinical status and the onset of pain the current study showed 24 patients with acute mesenteric vascular occlusion and six patients with chronic mesenteric vascular occlusion.…”

“…In Emara's study [20], the most prevalent MS intestinal findings in 30 patients with positive CT angiographic findings were bowel wall thickening in 16 patients (53.3%). These findings more or less matched with those reported by Serpa et.al in 2010 [22] followed by diminished wall enhancement was described in the contrast enhanced CT (CECT) series of 15 patients representing (50%) of cases, which is matched with Wong.…”

“…In the study of Emara et.al in 2018 [20] MSCT angiography detected accurately the cause of acute MVO, where portomesenteric venous thrombosis represented (70.8%) of acute MVO, however arterial occlusion was the cause in (20.8%) of patients and combined MAO and MVT (8.4%). SMA thromboembolism was described in all patients with acute MAO.…”

“…In the study of Emara et.al in 2018 [20] regarding the decreased bowel wall thickening which was detected in four cases, three cases with acute SMA thrombosis and one case due to mixed SMA and SMV thrombosis, the usual findings is marked thinning out of the bowel wall as compared to the adjacent normal bowel which means that it became paper like and even difficult to be measured. This was matching with Dhatt [29] who described thinning out of the ischemic bowel in cases mainly of arterial occlusion which is affecting the vasculature and muscle tone of the wall itself with consequent trans mural infarction.…”

“…Accurate diagnosis of MVO and its associated findings of the affected bowel are essential for proper management to decrease the morbidity and mortality and also to improve the patient's outcome. [20].…”