Skip to main content
Top
Published in: World Journal of Surgery 12/2007

01-12-2007

Acute Abdominal Pain: Diagnostic Impact of Immediate CT Scanning

Authors: Cecilia Strömberg, Gunnar Johansson, Anders Adolfsson

Published in: World Journal of Surgery | Issue 12/2007

Login to get access

Abstract

Background

Acute abdominal pain is a common diagnostic problem. This study aimed to evaluate the routinely use of contrast enhanced computed tomographic (CT) scanning early in the diagnostic process.

Methods

A retrospective review of 2,222 patients with acute abdominal pain who underwent contrast enhanced CT scanning within 24 h after admission. The diagnoses obtained were compared with the final diagnoses after 1 month.

Results

After CT scanning the following diagnoses were suggested as the primary cause of the abdominal pain: nonspecific abdominal pain 984 (44.3%), appendicitis 354 (15.9%), bowel obstruction 190 (8.6%), diverticulitis 182 (8.2%), gastrointestinal perforation 52 (2.3%), gallstone disease 64 (2.9%), pancreatitis 72 (3.2%), inflammatory bowel disease 13 (0.6%), intra-abdominal malignancy 34 (1.5%), vascular disease (including 1 completely cured patient with paradoxical embolization in the superior mesenteric artery) 33 (1.5%), urological 131 (5.9%), gynecological 54 (2.4%), miscellaneous 31 (1.4%). In 28 cases a conclusive CT examination could not be carried out. The suggested diagnoses were correct in 2,151 cases (96.8%). In 16 cases (0.7%) an incorrect diagnosis was reported, leading to 7 unnecessary laparotomies. False negative reports were obtained in 27 cases (1.2%). After CT examination 500 patients could be discharged immediately.

Conclusions

Contrast-enhanced CT scanning results in superior diagnostic precision in patients with acute abdominal pain. The present work supports the strategy to include this examination early in the routine diagnostic process.
Literature
1.
go back to reference Fenyö G, Boijsen M, Enochsson L, et al. (2000) Acute abdomen calls for considerable care resources. Analysis of 3,727 in-patients in Stockholm County in the first quarter of 1995. Läkartidningen 97:4008–4012PubMed Fenyö G, Boijsen M, Enochsson L, et al. (2000) Acute abdomen calls for considerable care resources. Analysis of 3,727 in-patients in Stockholm County in the first quarter of 1995. Läkartidningen 97:4008–4012PubMed
2.
go back to reference Silen W (2005) Cope’s Early Diagnosis of the Acute Abdomen, 21st Edition. New York, Oxford University Press Silen W (2005) Cope’s Early Diagnosis of the Acute Abdomen, 21st Edition. New York, Oxford University Press
3.
go back to reference Martin RF, Rossi RL (1997) The acute abdomen. An overview and algorithms. Surg Clin North Am 77:1227–1243PubMedCrossRef Martin RF, Rossi RL (1997) The acute abdomen. An overview and algorithms. Surg Clin North Am 77:1227–1243PubMedCrossRef
4.
go back to reference Andersson RE, Hugander AP, Ghazi SH, et al. (2000) Why does the clinical diagnosis fail in suspected appendicitis? Eur J Surg 166:796–802PubMedCrossRef Andersson RE, Hugander AP, Ghazi SH, et al. (2000) Why does the clinical diagnosis fail in suspected appendicitis? Eur J Surg 166:796–802PubMedCrossRef
5.
go back to reference Tepel J, Sommerfeld A, Klomp H-J, et al. (2004) Prospective evaluation of diagnostic modalities in suspected acute appendicitis. Langenbecks Arch Surg 389:219–224PubMedCrossRef Tepel J, Sommerfeld A, Klomp H-J, et al. (2004) Prospective evaluation of diagnostic modalities in suspected acute appendicitis. Langenbecks Arch Surg 389:219–224PubMedCrossRef
6.
go back to reference Gore RM, Miller FH, Pereles FS, et al. (2000) Helical CT in the evaluation of the acute abdomen. AJR Am J Roentgenol 174:901–913PubMed Gore RM, Miller FH, Pereles FS, et al. (2000) Helical CT in the evaluation of the acute abdomen. AJR Am J Roentgenol 174:901–913PubMed
7.
go back to reference Ng CS, Watson CJE, Palmer CR, et al. (2002) Evaluation of early abdominopelvic computed tomography inpatients with acute abdominal pain of unknown cause: prospective randomised study. BMJ 325:1387–1389PubMedCrossRef Ng CS, Watson CJE, Palmer CR, et al. (2002) Evaluation of early abdominopelvic computed tomography inpatients with acute abdominal pain of unknown cause: prospective randomised study. BMJ 325:1387–1389PubMedCrossRef
8.
go back to reference Rosen MP, Siewert B, Sands DZ, et al. (2003) Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 13:418–424PubMed Rosen MP, Siewert B, Sands DZ, et al. (2003) Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 13:418–424PubMed
9.
go back to reference Salem TA, Molloy RG, O’Dwyer PJ (2005) Prospective study on the role of the CT scan in patients with an acute abdomen. Colorectal Dis 7:460–466PubMedCrossRef Salem TA, Molloy RG, O’Dwyer PJ (2005) Prospective study on the role of the CT scan in patients with an acute abdomen. Colorectal Dis 7:460–466PubMedCrossRef
10.
go back to reference Johnson CD, Baker ME, Rice RP, et al. (1987) Diagnosis of acute colonic diverticulitis: comparison of barium enema and CT. AJR Am J Roentgenol 148:541–546PubMed Johnson CD, Baker ME, Rice RP, et al. (1987) Diagnosis of acute colonic diverticulitis: comparison of barium enema and CT. AJR Am J Roentgenol 148:541–546PubMed
11.
go back to reference Stapakis JC, Thickman D (1992) Diagnosis of pneumoperitoneum: abdominal CT vs upright chest film. J Comput Assist Tomogr 16:713–716PubMedCrossRef Stapakis JC, Thickman D (1992) Diagnosis of pneumoperitoneum: abdominal CT vs upright chest film. J Comput Assist Tomogr 16:713–716PubMedCrossRef
12.
go back to reference Taourel PG, Deneuville M, Pradel JA, et al. (1996) Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology 199:632–636PubMed Taourel PG, Deneuville M, Pradel JA, et al. (1996) Acute mesenteric ischemia: diagnosis with contrast-enhanced CT. Radiology 199:632–636PubMed
13.
go back to reference Dalzell DP, Scharling ES, Ott DJ, et al. (1998) Acute pancreatitis: the role of diagnostic imaging. Crit Rev Diagn Imaging 39:339–363PubMed Dalzell DP, Scharling ES, Ott DJ, et al. (1998) Acute pancreatitis: the role of diagnostic imaging. Crit Rev Diagn Imaging 39:339–363PubMed
14.
go back to reference Rao PM, Rhea JT, Novelline RA, et al. (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 338:141–146PubMedCrossRef Rao PM, Rhea JT, Novelline RA, et al. (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 338:141–146PubMedCrossRef
15.
go back to reference Burkill GJC, Bell JRG, Healy JC (2001) The utility of computed tomography in acute small bowel obstruction. Clin Radiol 56:350–359PubMedCrossRef Burkill GJC, Bell JRG, Healy JC (2001) The utility of computed tomography in acute small bowel obstruction. Clin Radiol 56:350–359PubMedCrossRef
16.
go back to reference Khurana B, Ledbetter S, McTavish J, et al. (2002) Bowel obstruction revealed by multidetector CT. AJR Am J Roentgenol 178:1139–1144PubMed Khurana B, Ledbetter S, McTavish J, et al. (2002) Bowel obstruction revealed by multidetector CT. AJR Am J Roentgenol 178:1139–1144PubMed
17.
go back to reference Delabrousse E, Destrumelle N, Brunelle S, et al. (2003) CT of small bowel obstruction in adults. Abdom Imaging 28:257–266PubMedCrossRef Delabrousse E, Destrumelle N, Brunelle S, et al. (2003) CT of small bowel obstruction in adults. Abdom Imaging 28:257–266PubMedCrossRef
18.
go back to reference Taourel P, Kessler N, Lesnik A, et al. (2003) Helical CT of large bowel obstruction. Abdom Imaging 28:267–275PubMedCrossRef Taourel P, Kessler N, Lesnik A, et al. (2003) Helical CT of large bowel obstruction. Abdom Imaging 28:267–275PubMedCrossRef
19.
go back to reference Kaiser S, Finnbogason T, Jorulf HK, et al. (2004) Suspected appendicitis in children: diagnosis with contrast-enhanced versus nonenhanced helical CT. Radiology 231:293–295CrossRef Kaiser S, Finnbogason T, Jorulf HK, et al. (2004) Suspected appendicitis in children: diagnosis with contrast-enhanced versus nonenhanced helical CT. Radiology 231:293–295CrossRef
20.
go back to reference Rhea JT, Halpern EF, Ptak T, et al. (2005) The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients. AJR Am J Roentgenol 184:1802–1808PubMed Rhea JT, Halpern EF, Ptak T, et al. (2005) The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients. AJR Am J Roentgenol 184:1802–1808PubMed
21.
go back to reference United Nations Scientific Committee on the Effects of Atomic Radiation (2000) Sources and Effects of Ionizing Radiation. New York, United Nations United Nations Scientific Committee on the Effects of Atomic Radiation (2000) Sources and Effects of Ionizing Radiation. New York, United Nations
22.
go back to reference Berrington de González A, Darby S (2004) Risk of cancer from diagnostic x-rays: estimates for the UK and 14 other countries. Lancet 363:345–351CrossRef Berrington de González A, Darby S (2004) Risk of cancer from diagnostic x-rays: estimates for the UK and 14 other countries. Lancet 363:345–351CrossRef
23.
go back to reference Laurell H, Hansson L-E, Gunnarsson U (2006) Acute abdominal pain in a defined population—the impact of the formal competence of the physician and the use of structured schedule for investigation. In Laurell H, Acute Abdominal Pain (PhD dissertation), Uppsala University, Uppsala, Sweden Laurell H, Hansson L-E, Gunnarsson U (2006) Acute abdominal pain in a defined population—the impact of the formal competence of the physician and the use of structured schedule for investigation. In Laurell H, Acute Abdominal Pain (PhD dissertation), Uppsala University, Uppsala, Sweden
24.
go back to reference Velanovich V, Satava R (1992) Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance. Am Surg 58:264–269PubMed Velanovich V, Satava R (1992) Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance. Am Surg 58:264–269PubMed
25.
go back to reference Calder JDF, Gajraj H (1995) Recent advances in the diagnosis and treatment of acute appendicitis. Br J Hosp Med 54:129–133PubMed Calder JDF, Gajraj H (1995) Recent advances in the diagnosis and treatment of acute appendicitis. Br J Hosp Med 54:129–133PubMed
26.
go back to reference Fenyö G, Lindberg G, Blind P, et al. (1997) Diagnostic decision support in suspected acute appendicitis: validation of a simplified scoring system. Eur J Surg 163:831–838PubMed Fenyö G, Lindberg G, Blind P, et al. (1997) Diagnostic decision support in suspected acute appendicitis: validation of a simplified scoring system. Eur J Surg 163:831–838PubMed
27.
go back to reference Laurell H, Hansson L-E, Gunnarsson U (2006) Manifestations of acute appendicitis—a prospective study on acute abdominal pain. In Laurell H, Acute Abdominal Pain (PhD Dissertation). Uppsala, Sweden, Uppsala University Laurell H, Hansson L-E, Gunnarsson U (2006) Manifestations of acute appendicitis—a prospective study on acute abdominal pain. In Laurell H, Acute Abdominal Pain (PhD Dissertation). Uppsala, Sweden, Uppsala University
28.
go back to reference Laurell H, Hansson L-E, Gunnarsson U (2006) Acute abdominal pain among elderly patients. Gerontology 52:339–344PubMedCrossRef Laurell H, Hansson L-E, Gunnarsson U (2006) Acute abdominal pain among elderly patients. Gerontology 52:339–344PubMedCrossRef
30.
go back to reference Blomgren LGM (1997) Perforated peptic ulcer: long-term results after simple closure in the elderly. World J Surg 21:412–415PubMedCrossRef Blomgren LGM (1997) Perforated peptic ulcer: long-term results after simple closure in the elderly. World J Surg 21:412–415PubMedCrossRef
31.
go back to reference Gore RM, Yaghmai V, Newmark GM, et al. (2002) Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 40:1307–1323PubMedCrossRef Gore RM, Yaghmai V, Newmark GM, et al. (2002) Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 40:1307–1323PubMedCrossRef
32.
go back to reference Acosta S, Björck M (2003) Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population. Eur J Vasc Endovasc Surg 26:179–183PubMedCrossRef Acosta S, Björck M (2003) Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population. Eur J Vasc Endovasc Surg 26:179–183PubMedCrossRef
33.
go back to reference Schoots IG, Koffeman GI, Legemate DA, et al. (2004) Systematic review of survival after acute mesenteric ischemia according to disease aetiology. Br J Surg 91:17–27PubMedCrossRef Schoots IG, Koffeman GI, Legemate DA, et al. (2004) Systematic review of survival after acute mesenteric ischemia according to disease aetiology. Br J Surg 91:17–27PubMedCrossRef
34.
go back to reference Acosta S, Ögren M, Sternby N-H, et al. (2004) Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery—a population-based study. Eur J Vasc Endovasc Surg 27:145–150PubMedCrossRef Acosta S, Ögren M, Sternby N-H, et al. (2004) Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery—a population-based study. Eur J Vasc Endovasc Surg 27:145–150PubMedCrossRef
35.
go back to reference Moore EM, Endean ED (2005) Treatment of acute intestinal ischemia caused by arterial occlusions. In Rutherford RB, editor, Vascular Surgery, 6th Edition, Philadelphia, Elsevier-Saunders, 1718–1728 Moore EM, Endean ED (2005) Treatment of acute intestinal ischemia caused by arterial occlusions. In Rutherford RB, editor, Vascular Surgery, 6th Edition, Philadelphia, Elsevier-Saunders, 1718–1728
36.
go back to reference Johansson G, Swedenborg J (1986) Ruptured abdominal aortic aneurysms: a study of incidence and mortality. Br J Surg 73:101–103PubMedCrossRef Johansson G, Swedenborg J (1986) Ruptured abdominal aortic aneurysms: a study of incidence and mortality. Br J Surg 73:101–103PubMedCrossRef
37.
go back to reference Hinchliffe RJ, Bruijstens L, MacSweeney STR, et al. (2006) A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysm—results of a pilot study and lessons learned for future studies. Eur J Vasc Endovasc Surg 32:506–513PubMedCrossRef Hinchliffe RJ, Bruijstens L, MacSweeney STR, et al. (2006) A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysm—results of a pilot study and lessons learned for future studies. Eur J Vasc Endovasc Surg 32:506–513PubMedCrossRef
Metadata
Title
Acute Abdominal Pain: Diagnostic Impact of Immediate CT Scanning
Authors
Cecilia Strömberg
Gunnar Johansson
Anders Adolfsson
Publication date
01-12-2007
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 12/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-007-9233-x

Other articles of this Issue 12/2007

World Journal of Surgery 12/2007 Go to the issue