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Research Paper | Surgery | India | Volume 12 Issue 6, June 2023 | Rating: 5.3 / 10
Proposed Diagnostic Pathway in Various Conditions / Diseases Leading to Urgent Cases of Acute Abdomen
Dr. Ashi Verma | Dr. K. K. Singh | Dr. Dhirendra Pratap | Dr. Surendra Kumar [10]
Abstract: Background: The sensitivity of medical history, physical examination, and laboratory values are higher for differentiating urgent acute abdomen from non-urgent cause. Radiological tests like x-ray, ultrasonography (USG), and CT scans are needed in cases of diagnostic uncertainty. However, it increases the overall cost and waiting time. The present study was performed to study the diagnostic accuracy of clinical evaluation and imaging to detect urgent acute abdomen so that a diagnostic pathway may be formulated for resource deficient countries. Methodology: 60 patients, who presented with acute abdomen, were categorised as urgent and non urgent surgical condition and underwent laparotomy. A detailed history of all the patients was taken along with thorough clinical examination and laboratory investigation findings; thereafter various radiological imaging modalities were used in a prescribed way. Diagnosis after clinical evaluation and various imaging modalities was made separately and compared to the final diagnosis. Results: The overall diagnostic accuracy of clinical evaluation alone was 58.33%. But the diagnostic accuracy in cases of obstructed hernia, adhesive acute intestinal obstruction, appendicular perforation, post D&C perforation, and enteric perforation with a history of fever was 100%. In patients where the decision to undergo emergency laparotomy was clear after clinical evaluation/USG, a CT scan was not done. Hence, the overall diagnostic accuracy after conditional imaging was 71.67% only. However, the 7 cases in which CT scan was done, had an accuracy of 100%. Conclusion: Patients of obstructed hernia, post operative adhesive obstruction, appendicular perforation, gastric and duodenal perforation, post D&C perforation, and enteric perforation with a history of fever and sigmoid volvulus can be taken up for emergency laparotomy after clinical evaluation with or without X-Ray/ USG. However, in patients of carcinoma colon, carcinoma pancreas, Koch?s abdomen, enteric fever without history of fever, sealed perforation, diverticular and Meckel?s perforation, mesenteric ischemia cause SMA thrombosis and acute pancreatitis, CT scan/ MRI for pre-operative diagnosis is advisable, provided the patient is stable.
Keywords: Acute abdominal pain, Diagnostic accuracy, USG, CT scan, X-ray, Laparotomy
Edition: Volume 12 Issue 6, June 2023,
Pages: 2850 - 2856