Supine and erect abdominal radiographs are both feasible in patients with acute abdomen.

Abstract

DEAR EDITOR, We have read the article entitled “Diagnostic values of supine and erect abdominal radiographs for patients with acute abdomen: which is better for decision making?” published in the June issue of the Journal of the Chinese Medical Association with interest.1 Lee et al.1 tried to evaluate whether supine or erect abdominal radiographs are more suitable in cases of acute abdomen. The authors found that there was no significant difference in diagnostic sensitivity between the two modalities among all causes-inducing acute abdomen. As for bowel obstruction, the study revealed statistically better diagnostic relevance in erect abdominal radiographs. We congratulated the authors’ successful publication but there are some questions that need clarification. First, is it possible that one computed tomography (CT) scan reported more than one diagnosis? For example, a patient might simultaneously have a tubo-ovarian abscess associated with either adynamic ileus or obstructive bowel syndrome. Could the authors kindly provide the rationale about their strategy to evaluate the acute abdomen or whether their study would influence the further therapeutic plan (surgical intervention or conservative treatment)? Second, the authors concluded that erect abdominal radiographs were strongly suggested to use if highly suspected bowel obstruction. We appreciated the authors’ effort to propose this recommendation; however, no matter whether an erect or supine abdominal radiograph was used, it may hardly influence the decision and the subsequent management as shown above. In cases with extremely severe abdominal pain or uncertain diagnosis of acute abdomen, most of the clinicians may arrange a CT scan for further evaluation regardless of abdominal radiograph findings.2–5 Besides, it is uncomfortable and difficult for patients with acute abdomen to keep an erect posture. Additionally, the position of standing may be much detorted during the examination because of intolerance of pain. Despite the aforementioned questions, the authors provided evidence of abdominal radiographs choice regarding to acute abdomen.1 Based on this study, clinicians may save their time and effort to struggle with whether erect or supine abdominal radiographs should be taken. Though the CT scan had relatively higher accuracy, the importance and role of conventional radiographs or much convenient and little or absence of radiation-exposure ultrasound in the setting of emergency department should not be neglected.6,7 Especially in the era of the coronavirus disease 2019 (COVID-19) pandemic8,9, timely CT scan may be less available to individuals with acute abdomen. Also, conventional radiographs bring the least pressure to staff in hospital than other modalities for fear of getting infection.10 Overall, we appreciate the authors’ great work focusing on this topic. We hope to learn more from the authors with positive response. ACKNOWLEDGMENTS This article was supported by grants from the Taiwan Ministry of Science and Technology, Executive Yuan, Taiwan (MOST 110-2314-B-075-016-MY3 and MOST 111-2314-B-075-045), and Taipei Veterans General Hospital (V110C-082, and V111C-103). The authors appreciate the support from Female Cancer Foundation, Taipei, Taiwan.