The value of ultrasound in patients with acute onset of abdominal pain

Abstract

Emergency admissions with acute abdominal pain provide the gynaecologist with a large workload. There is a wide spectrum of differential diagnoses, including gynaecological and non-gynaecological causes—making the correct diagnosis can sometimes be challenging as the symptoms are largely subjective, and physical findings can be equivocal. Ultrasound scanning complements the physical examination but cannot replace the clinical history, which is essential. Ultrasound examination allows an assessment of the pelvis and abdomen and a transabdominal ultrasound scan should always be performed before a transvaginal scan so that large pelvic masses are not missed and causes of pain referred to the pelvis can be identified. Unlike laparoscopy, ultrasonongraphy carries no contraindications, and the procedure does not require a general anaesthetic. The technique is not, however, always appropriate. It is useful in patients who have symptoms and signs that do not indicate the presence of a specific condition requiring immediate surgery, but who may need surgery after a short period of observation and investigation. During scanning, the identification of areas of pain or discomfort can help with making the correct diagnosis. The majority of patients who present with acute abdominal pain and have a normal ultrasound scan show an improvement or resolution of their symptoms. The development of ultrasound has been a major advance in the management of bleeding in early pregnancy and is a quick, risk-free investigation, which should be used in the first-line management of patients with acute abdominal pain.