English

Abstract

The goal of the study was to evaluate the status of clinical diagnosis as well as diagnostic accuracy of easily available imaging techniques (X-ray, US, CT, etc.) in acute abdomen in a rural based teaching hospital. Here we present a prospectively conducted study including 118 patients presenting with features of acute abdomen irrespective of their age, sex, religions, marital and social status. After thorough history taking and clinical examinations, a straight x-ray abdomen, a chest x-ray, USG whole abdomen, CT scan of abdomen (if required), MRI (if required) were done. A provisional diagnosis was made on the basis of imaging findings. Then operative findings were noted if any surgery was required. Then a comparison was done to know that in what percentage of cases the diagnosis made by the available imaging techniques matched with the final diagnosis made on the basis of clinicopathological and operative findings. In our study among 45 cases of laparotomy other than appendicectomy, 39 cases were accurately diagnosed by x-ray (86.66%), USG was diagnostic in 36 cases (80%) and if both were used the sensitivity was raised up to 91%. So it is evident that x-ray is the only and most useful investigating modality in a case of acute abdomen. The overall diagnostic accuracy of clinical examination in acute abdomen is 71% and if imaging techniques are combined with this, the sensitivity raises up to 94.3%. INTRODUCTION: Acute abdomen can be defined as ‘a syndrome induced by wide variety of pathological conditions that require emergent medical or more often surgical treatment.’ 1 Many diseases, some of which are not surgical or intra-abdominal, can produce acute abdominal pain and tenderness. Therefore this challenging clinical scenario requires a thorough and expeditious work-up to determine the need for operative intervention and to initiate appropriate therapy. Approach to a patient with acute abdomen must be orderly and thorough. Clinical examination should suggest the probable cause and guide the choice of initial diagnostic tests. Supplementary laboratory and radiological investigations are indispensible for diagnosis of many surgical conditions, exclusion of medical causes and assistance for preoperative preparations. Now the availability and reliability of these diagnostic studies vary in different hospitals. Beside the wide clinic-pathological spectrum of acute abdomen, our study has focused over the aspect of diagnostic accuracy of available imaging techniques in this rural based teaching hospital. The importance of good history and examination in the assessment of acute abdomen was demonstrated in the 1970s by Late Tim de Dombal from Leeds and Tony Gunn from Scotland. USG since its use by Puylaert et al in 1986 for diagnosing acute abdomen preoperatively has shown itself to be a discerning modality for diagnosing acute abdominal pathology. It is as good as laparoscopy in diagnosing acute abdominal conditions and unlike laparoscopy it has no contraindications such as previous laparotomy & the procedure does not involve general anesthesia. 1 It is easily available, less