The Role of Noncontrast CT in the Evaluation of Surgical Abdomen Patients

Abstract

Acute surgical abdomen is commonly encountered in the ED and CT is widely used as an informative diagnostic tool to evaluate potential surgical indications. However, the adverse effects of contrast material used in CTscanning have been documented. We sought to delineate the role of noncontrast CT in the evaluation of patients with acute surgical abdomen. Between August 2015 and December 2015, patients with nontraumatic surgical abdomen who underwent preoperative CT were enrolled in the current study. The patients for whom the CT results permitted surgical decision-making were the focus of this study. The disease entities included acute appendicitis, acute cholecystitis, hollow organ perforation, mechanical bowel obstruction, intra-abdominal abscess that could not be drained percutaneously, and ischemic bowel disease. The results of contrast-enhanced and noncontrast CT were compared and analyzed. The surgical conditions identifiable by noncontrast CT were recorded. In total, 227 patients were enrolled in the study. In 90.7 per cent of patients overall, the findings indicating the need for surgical treatment were visualized on both the noncontrast and contrast-enhanced images (acute appendicitis: 89.3%, acute cholecystitis: 89.7%, hollow organ perforation: 97.4%, bowel obstruction: 100%, intra-abdominal abscess: 100%, and ischemic bowel disease: 55.6%). Noncontrast CT provides benefit for critical decision-making. Body mass index may affect the accuracy of noncontrast imaging in the evaluation of patients with surgical abdomen. In some specific situations, contrast enhancement remains necessary.

Сучасні Візуалізаційні Технології У Діагностиці Первинних Інтраабдомінальних Ускладнень У Хворих

“…У 90% випадків УЗД є базовим методом першочергового клінічного діагностичного підходу, і лише у складних клінічних випадках постає потреба у проведенні КТ-обстеження або магнітно-резонансної томографії (МРТ), особливо при підозрі на перфорацію порожнистого органу [3,5,7,9]. Застосування контрастної речовини значно підвищує специфічність та інформативність променевої діагностики в ургентній хірургії органів черевної порожнини до 90,7 та 97,4% відповідно [10].…”

Subacute small bowel obstruction or chronic large bowel obstruction

“…The sensitivity and specificity of plain x ray for small bowel obstruction are low, and abdominal computed tomography (CT) is the imaging modality of choice 1213. CT is not only highly sensitive for signs of obstruction even before the patient has many symptoms but also identifies the cause of the obstruction in the majority of cases 14.…”

Acute abdominal obstruction: Colon stent or emergency surgery? An evidence-based review

“…Computed tomography (CT) is recommended when MCO is suspected and[ 55 ] can confirm obstruction and clarify the level of the stricture, as well as identify the etiology of obstruction[ 41 , 56 ] .…”