Non-traumatic Acute Abdominal Pain Research Articles

Efficacy of ultrasound as a primary mode of investigation in the diagnosis of non-traumatic acute abdomen in pediatrics patients

Background: The role of diagnostic imaging is to determine whether the condition is medically or surgically treatable and, if possible, to diagnose the exact nature of the disease. Chest radiography is also commonly used to demonstrate extra-abdominal causes of acute abdominal pain, such as pneumonia. Ultrasonography is the initial choice of investigation that is likely useful to conclude for the following reasons, namely, it is relatively inexpensive, lack of radiation exposure, less time-consuming, easy, painless, and rarely requiring sedation. Usually, no preparation is required except in a few cases. It is also the preferred imaging tool for evaluating the surgical and non-surgical causes of acute abdomen in children. Ultrasound is also the preferred screening method for children suspected of having intra-abdominal mass. Aim and Objective: The present study is undertaken: (1) To identify specific causes of non-traumatic acute abdominal (NTA) pain in children; (2) to adopt the diagnostic efficacy of sonography as an initial tool for assessing those patients with probable clinical diagnosis; and (3) to triage patients for conservative or immediate surgery with available clinical diagnostic methods. Materials and Methods: A retrospective study of 100 pediatric patients aged between 1 and 14 years of both sexes with a history of non-traumatic acute abdomen attending outpatient services, in-patient, and emergency department at the Chamarajanagar Institute of Medical Sciences (CIMS) was conducted between March 2016 and March 2018 (for 2 years) for sonography. Results: Among 100 individuals, we had males followed by females (53%; 47%). The most common clinical symptoms of children with NTA were pain. Other symptoms included vomiting (66.7%; 15%), fever (68.5%; 31.6%), diarrhea (40%; 60%), cough (50%; 50%), and constipation (1%; 1%). The maximum number of cases in the group was >5 years–14 years. The most common sonography findings in this study were non-specific mesenteric lymphadenitis 49.4%, appendicitis (18.7%), intussusception, and cystitis (6.7%). followed by renal hydronephrosis (5.3%). Conclusion: Sonography, along with the associated clinical features, is a valuable adjuvant for a probable diagnosis. Other investigations such as laboratory findings, contrast-enhanced CT scan as indicated by the patient’s condition and requirement can be supported. This is particularly important in C-grade locations where other higher modes of investigation may not be available.

A retrospective study of patients complaining of nontraumatic acute abdominal pain, admitted in the emergency department of an urban hospital in China

Abstract Background Nontraumatic acute abdominal pain (AAP) accounts for a large proportion of emergency department (ED) admissions. This study aimed to explore the underlying correlations among basic information, imaging examinations, and diagnoses. Methods A total of 7453 patients complaining of AAP, admitted to the ED of Zhongnan Hospital of Wuhan University, were enrolled in this retrospective study from January 1 to December 30, 2019. We collected the following information from the patients: sex, age, date of visit, pain location, nature of pain, level of severity, imaging (computed tomography, x-ray, and ultrasound), diagnosis, and outcomes (release from the hospital, transfer to another hospital, transfer to another department, observation room, hospitalization, or death). Results According to this study, AAP was more common in female than male. A total of 82.11% patients of AAP were in level 3 of severity, while 0.19% patients were in level 1. A total of 77.20% of the patients had undergone imaging. Swelling pain and colic are the 2 most common types of AAP. Nonspecific abdominal pain (NSAP) is the most common diagnosis. In the diagnosis of NSAP and gastroenteritis, female patients were more prevalent than male patients, but for renal colic, male patients were 3 times as many as female patients. Nonspecific abdominal pain, biliary colic, and cholecystitis are the 3 leading causes in patients 65 years or older. Nonspecific abdominal pain, renal colic, and gastroenteritis are the 3 leading causes of AAP in patients younger than 65 years. Conclusion With the help of imaging, clinicians can specify a diagnosis and perform corresponding treatment in most cases. However, making a precise diagnosis of AAP within a short period is still challenging. Further research should be conducted to seek safer and more effective techniques to streamline clinicians’ work.

Linear Combination of Leukocyte Count and D-Dimer Levels in the Diagnosis of Patients with Non-traumatic Acute Abdomen

Aim: Rapid intervention is required in patients with non-traumatic acute abdominal pain. It is very important to distinguish between surgical and non-surgical pathologies during this intervention. This study aimed to increase the diagnostic accuracy by combining the leukocyte count and D-dimer levels used in this evaluation with linear combination methods. Materials and Methods: Logistic regression, scoring, min-max, minimax, Su & Liu, Pepe & Thompson, Pepe, Cai & Langton, and Todor & Saplacan methods were used as linear combination methods. The data set was divided into 70% training set and 30% test set. Parameter optimization was performed on the training data by 5 fold cross-validation method using 10 repeats. The area under the ROC curve, sensitivity, selectivity, accuracy, positive and negative predictive value, and positive and negative likelihood ratio statistics were used in the performance evaluation.Results: The area under the ROC curve statistic for D-dimer level and log-transformed leukocyte count variable were obtained as 0.71 and 0.70, respectively. The accuracy rate was 0.69 for the D-dimer level and 0.73 for log-transformed leukocyte count. For the linear combination methods, the area under the ROC curve was between 0.77 and 0.81, and the accuracy statistics were between 0.72 and 0.79. The best performance was obtained with the min-max method.Conclusion: In patients with non-traumatic acute abdominal pain, leukocyte count and D-dimer levels can be evaluated together by using linear combination methods in differentiating surgical and non-surgical pathologies. The obtained results showed that the diagnostic performance of the combined results with the min-max procedure was higher than the leukocyte count and D-dimer levels.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Role of computed tomography in non-traumatic acute abdomen in adults

Background: The objective of this study was to study, assess, and diagnose causes of acute abdomen accurately, to determine the accuracy of multidetector computed tomography (CT) for confirmation of negative, diagnosed, or equivocal ultrasonography (USG) cases, and to establish role of CT as the primary imaging modality. Aims and Objective: To study, assess and diagnose causes of acute abdomen accurately, To determine the accuracy of MDCT for confirmation of Negative, diagnosed or equivocal USG cases & To establish role of CT as the primary imaging modality. Materials and Methods: One hundred and twenty random patients were included in this prospective study. USG and CT were done in all patients. Axial, coronal, and sagittal reformatted images were studied. Intravenous and oral contrast were also used depending on the clinical condition. All these patients were followed up diagnosis obtained before and after CT were compared with intraoperative findings or final clinical diagnosis at discharge. Results: Among 120 patients, confirmative CT diagnosis was made in 111 cases and was discordant in seven cases, while two cases could not be followed up. Forty-five cases underwent surgical management and rest of them were managed medically. Conclusion: CT abdomen done in patients presenting with non-traumatic acute abdominal pain which helps to make accurate diagnosis and planning the appropriate treatment.

CAN ULTRASOUND ALONE SUFFICE IN THE EVALUATION OF ACUTE ABDOMEN IN ADULTS – A COMPARATIVE COMPUTED TOMOGRAPHY VERSUS ULTRASOUND (HOSPITAL BASED) STUDY

OBJECTIVE The objective of this study was to study the role of ultrasound and computed tomography in evaluation of acute abdomen and to assess whether ultrasound alone will sufce in majority situations, so that radiation exposure may be minimized. MATERIALS AND METHODS This institutional review board approved prospective observational study comprised of 50 adult patients attending the emergency department for non-traumatic acute abdominal pain less than 3 days of duration. The radiological evaluation with US and CT scan (Non contrast and contrast enhanced) of abdomen was done at radiology department of Sharda hospital. The exclusion criteria were trauma and pregnancy. The equipments used were Ultrasound with color Doppler PHILIPS EPIQ 7G and CT Scan - GE Optima 660 - 128 slice CT Scanner with slice thickness of 0.6 mm. RESULTS The overall sensitivity of US was 74% and that of CT was 96.15% with insignicant difference (p value – 0.018). Also, the sensitivity of US compared to CT in diagnosing common etiologies of acute abdomen namely acute cholecystitis, acute appendicitis, intestinal obstruction, pancreatitis and ureteric calculi sensitivity did not differ signicantly. CT was necessary only in patients with retro-caecal appendicitis, bowel obstruction cases for dening the transition point and in patients with pancreatitis to obtain the CT Severity index. CONCLUSION We propose that US should remain the primary imaging modality in all patients of acute abdomen in order to prevent radiation exposure, especially as it was found to have a sensitivity comparable to CT, in majority of the clinical situations. Moreover, it is a more cost-effective investigation. Therefore, CT should be reserved only for the minority of clinical situations where US is signicantly inconclusive.

Teleradiology as a relevant indicator of the impact of COVID-19 pandemic management on emergency room activities: a nationwide worrisome survey

ObjectivesTo evaluate the impact of COVID-19’s lockdown on radiological examinations in emergency services.MethodsRetrospective, multicentre analysis of radiological examinations requested, via our teleradiology network, from 2017 to 2020 during two timeframes (calendar weeks 5–8 and then 12–15). We included CT scans or MRIs performed for strokes, multiple traumas (Body-CT), cranial traumas (CTr) and acute non-traumatic abdominal pain (ANTAP). We evaluated the number and percentages of examinations performed, of those with a pathological conclusion, and of examinations involving the chest.ResultsOur study included 25 centres in 2017, 29 in 2018, 43 in 2019 and 59 in 2020. From 2017 to 2019, the percentages of examinations were constant, which was also true for chest CTs. Each centre’s number of examinations, gender distribution and patient ages were unchanged. In 2020, examinations significantly decreased: suspected strokes decreased by 36% (1052 vs 675, p < 0.001), Body-CT by 62% (349 vs 134, p < 0.001), CTr by 52% (1853 vs 895, p < 0.001) and for ANTAP, appendicitis decreased by 38% (45 vs 90, not statistically significant (NS)) sigmoiditis by 44% (98 vs 55, NS), and renal colic by 23% (376 vs 288, NS). The number of examinations per centre decreased by 13% (185.5 vs 162.5, p < 0.001), whereas the number of examinations of the "chest" region increased by 170% (1205 vs 3766, p < 0.001).ConclusionTeleradiology enabled us to monitor the impact of the COVID-19 pandemic management on emergency activities, showing a global decrease in the population's use of care.

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis.

PurposeThis study examined the impact of the COVID-19 pandemic on emergency department CT use for acute nontraumatic abdominal pain, to better understand why imaging volume so drastically decreased during the COVID-19 pandemic.MethodsThis was a retrospective review of emergency imaging volumes from January 5 to May 30, 2020. Weekly volume data were collected for total imaging studies, abdominopelvic CT, and abdominopelvic CTs positive for common causes of acute nontraumatic abdominal pain. Two emergency radiology attendings scored all diverticulitis cases independently, and weekly volume data for uncomplicated and complicated diverticulitis cases was also collected. Volume data prior to and during the COVID-19 pandemic was compared, using 2019 volumes as a control.ResultsDuring the COVID-19 pandemic, overall emergency imaging volume decreased 30% compared to 2019 (p = 0.002). While the number of emergency abdominopelvic CTs positive for appendicitis and small bowel obstruction did not significantly change during the COVID-19 pandemic, the number of cases of diverticulitis decreased significantly compared to 2019 (p = 0.001). This reduction can be specifically attributed to decreased uncomplicated diverticulitis cases, as the number of uncomplicated diverticulitis cases dropped significantly (p = 0.002) while there was no significant difference in the number of complicated diverticulitis cases (p = 0.09).ConclusionsReduced emergency abdominopelvic CT volume during the COVID-19 pandemic can partially be explained by decreased imaging of lower acuity patients. This data may help formulate future strategies for imaging resource utilization with an improved understanding of the relationship between perceived imaging risk and symptom acuity.

An audit of local discrepancy rates in acute abdominal CT: does subspecialist reporting reduce discrepancy rates?

To assess the discrepancy rates (DR) for patients undergoing abdominopelvic computed tomography (CT) for acute non-traumatic abdominal pain who have a subsequent emergency laparotomy in a large university teaching hospital, in particular identifying the differences between subgroups of reporters, to assess factors that may influence the discrepancy rates, to examine the pathologies with the highest discrepancy rate, to identify learning points, and give recommendations on current practice. The surgical data and CT reports of 1,176 patients who underwent urgent laparotomy after CT from 2014-2018 in a large university hospital were analysed retrospectively. A major discrepancy was defined as an error of fact in the radiology report, which led to incorrect management or patient harm. Registrars have higher DR than consultants (6.86% versus 2.77%). The major DR for consultants met national standards (<5%). The major DRs for registrars met the national audit standard (<10%), but not the National Emergency Laparotomy Audit (NELA) standard (<5%). When comparing between reporter subgroups, gastrointestinal (GI) radiologists have a lower major DR than general radiologists (1.22% versus 3.44%). GI radiologists were also found to correct more registrar provisional reports. The existence of a documented preoperative discussion between radiologists and surgeons was associated with a lower DR. DR for registrars and consultants are below the national audit standard. Several factors associated with a lower DR in acute abdominopelvic CT were also identified, including reporting by consultants, reporting by GI radiologists and preoperative discussions between the radiologist and surgeon.

A study on the incidence of abdominal malignancies presenting as acute abdomen in an emergency department

Background: Acute abdomen is one of the most common symptoms that bring a patient to an emergency department. An abdominal malignancy may be the cause of acute abdomen at least in a number of cases. The problem with this is the poorer outcome associated with it due to the lack of preoperative evaluation and preparation and also possible contamination that occurs in case of a perforation. This study aimed at studying the incidence of abdominal malignancies in the patients presenting as acute abdomen and the various presentations in which they present.Methods: Patients who presented with non-traumatic acute abdominal pain in the emergency department at our hospital who required surgery for acute abdomen were taken for the study and the incidence of malignancy in these cases were statistically assessed.Results: Out of the 375 patients who were operated for non-traumatic acute abdomen 62 patients i.e. 16.53% were found to have intraabdominal malignancy. Carcinoma colon was the commonest malignancy, 51.6%. Carcinoma stomach and rectum were the next most common malignancy. Commonest presentation was as a case of intestinal obstruction, 72.6% followed by perforation, 20.9%.Conclusions: In the era were the incidence and early detection of abdominal malignancies are on a rise, a significant portion of these cases present with acute abdominal symptoms and the morbidity associated with such a presentation is of importance. Early detection of the disease by screening is the solution for this.

Clinical Utility of Carnett and closed eye sign in emergency department.

Carnett's sign (CAR) and Closed Eye sign (CE) have been suggested for use in the emergency department setting in the management of abdominal pain. The present study sought to determine the sensitivity/specificity of CAR and CE for pathological CT findings as a primary outcome and for subsequent hospital admission or surgical intervention as secondary outcomes in a community emergency department setting. A convenience sample of adults (≥18 y) presenting with acute (<48h) nontraumatic and non-postoperative abdominal pain determined by treating provider to warrant CT imaging were eligible for enrollment. Treating providers completed a datasheet describing physical examination findings prior to CT imaging. 320 patients were enrolled. 245/320 (76.5%) of enrolled patients had findings on CT Imaging. CAR+ was recorded in 145 and CAR- in 175 patients. CE+ was in 187 and CAR- in 133 patients. Sensitivity and specificity of CAR- for hospital admission was 42.2% and 38.9% and for surgery-44.8% and 43.1%. Sensitivity and specificity of CE- for hospital admission was 28% and 51.6% and for surgery-25.9% and 55%. CAR+ patients were more likely to be admitted or undergo surgery as compared to CAR-. CE+ patients were more likely to be admitted or undergo surgery as compared to CAR-. There were no differences in frequency of pathological CT findings between CAR+ and CAR- or CE+ and CE- patients. CAR and CE are neither sufficiently sensitive nor specific for use in the emergency department setting. CT findings were equally likely in CAR+ and CAR- patients. CT Findings were also equally likely in CE+ and CE- patients.

Routine versus selective computed tomography in non-traumatic acute abdominal pain: meta-analysis of randomised trials.

To compare the routine vs. selective use of computed tomography (CT) in patients presenting with non-traumatic acute abdominal pain (AAP) to a surgical service. We conducted a systematic review of literature and meta-analysis of outcomes according to PRISMA statement standards to compare the routine vs. selective use of CT in adult patients presenting with non-traumatic AAP. Analysis of 722 patients from 4 randomised controlled trials showed no difference between the routine CT and selective CT groups in terms of proportion of correct diagnoses (OR 1.36,95% CI 0.89, 2.07, P = 0.15), mortality (RD 0.03, 95% CI - 0.08, 0.02, P = 0.27] and length of hospital stay (LOS) [MD - 0.26, 95% CI - 2.07, 1.55, P = 0.78). The routine use of CT does not improve the proportion of correct diagnoses and mortality compared to selective use of CT in adult patients with non-traumatic AAP. The available evidence regarding the influence of routine CT on LOS may be subject to type 2 error. These findings, however, may not apply to the elderly patient with AAP and further studies are required.

Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

Objectives:This prospective study was performed to evaluate the diagnostic accuracy of bedside point‐of‐care abdominal ultrasonography performed by emergency physician in patients with non‐traumatic acute abdominal pain.Methods:The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point‐of‐care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard.Results:The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point‐of‐care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients.Conclusion:This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point‐of‐care abdominal ultrasonography after training.

Role of Ultrasound Scan in Non-Traumatic Acute Abdomen Presenting in Surgery Department of a Tertiary Care Center

Introduction: An acute abdomen is defined as a clinical condition characterized by severe abdominal pain developing suddenly over several hours or less. Ultrasonography (USG) helps the managing surgeons arrive at early diagnosis and rule out alternative diseases, thus reducing negative laparotomy rate. This study analyzed the diagnostic yield of USG in patients with non-traumatic acute abdomen presenting to Surgery department via Emergency department/outpatient department of a tertiary hospital. Methods: This cross-sectional observational study included 110 patients with non-traumatic acute abdominal pain who were sent for USG examination. The percentage concordance of USG diagnosis with the final diagnosis at discharge was determined in terms of sensitivity, specificity, positive and negative predictive values for acute abdomen. Results: Of 110 patients, correct clinical diagnosis was made in 83 patients (75%) while USG made a correct diagnosis in 101 patients (91%). Hence, with the help of USG, accuracy of diagnosing cause of acute abdomen increased by 16 %. The sensitivity and specificity of USG in diagnosis of acute appendicitis were 87.7% and 98.3% respectively. Conclusion: USG is easily available and non-invasive modality without radiation exposure and requiring minimal patient preparation. USG should, therefore, be an important routine diagnostic investigation in patients presenting with acute abdomen.

Significance of Intra-abdominal Free Fluid Detected in Ultrasonography in the Clinical Assessment and Outcomes of Adult Patients Presenting to the Emergency Department Due to Abdominal Pain.

ObjectiveThe aim of the study was to evaluate the diagnostic process and clinical course in adult patients who presented to the emergency department (ED) with acute abdominal pain (AAP) and were found to have intra-abdominal free fluid (FF) on ultrasonography (USG).MethodsThis prospective observational study was conducted in a training and research hospital adult emergency department between March 15, 2013, and April 15, 2013. The study included 252 patients aged above 18 years, who were admitted to the emergency room complaining of non-traumatic acute abdominal pain and provided consent for the study.ResultsThe most common diagnoses were acute, nonspecific abdominal pain (37.3%), acute appendicitis (19%), and urinary tract pathology (15.9%). Intra-abdominal free fluid was detected with ultrasonography in 42.5% of patients. Patients with intra-abdominal free fluid were younger than the other patients. The emergency department length of stay was longer in patients with intra-abdominal free fluid (p=0.011). Of the 252 patients enrolled in the study, 32.9% were admitted to the hospital, 21.4% of whom underwent surgery and 11.5% received medical therapy. Most of the patients (64.5%) who were discharged home had no intra-abdominal free fluid in the ultrasonography (p<0.001).ConclusionThe presence of intra-abdominal free fluid alone did not guide the clinical decision regarding the diagnostic evaluation of adult patients that presented to the emergency department complaining of non-traumatic acute abdominal pain.

Emergency CT for acute non-traumatic abdominal pain: does sub-specialist GI radiologist reporting reduce discrepancy rates?

Category: GI.

Diagnostic imaging for acute abdominal pain in an Emergency Department in Italy

Imaging plays a key role in the diagnostic work-up of patients with non-traumatic acute abdominal pain (AAP) in emergency department (ED). We aimed to evaluate the use and diagnostic performance of imaging techniques in adult patients with AAP in an ED in Italy. Patients with non-traumatic AAP admitted at the ED of S. Orsola-Malpighi University Hospital of Bologna (Italy) from the 1st to the 30th November 2016 were included. Demographic and clinical data, data on radiological procedures and discharge diagnosis were collected. Sensitivity and specificity for detecting acute diseases were assessed using the discharge diagnosis from the ED as reference standard. Of the 578 patients (female 52.8%, mean age 51.3years) admitted to the ED for AAP, 433 (74.9%) underwent abdominal imaging. The most frequent techniques used were abdominal plain radiography and ultrasonography (US), performed in 38.4% and 37.9% of patients, respectively, followed by computed tomography (CT) in 28% of patients. Plain radiography yielded a sensitivity of 28% and specificity of 91.1%; the sensitivity increased to 79.4% in patients with small bowel obstruction. Ultrasonography's sensitivity and specificity were 61.8% and 98.4%, respectively; the sensitivity of US reached 85.2% and 90% in patients with acute cholecystitis/biliary colic and urolithiasis, respectively. The sensitivity and specificity of CT were 87.8% and 92.9%, respectively. Plain radiography is still overused in the diagnostic work-up of AAP in ED in Italy, despite its unsatisfactory sensitivity. Ultrasonography and CT has a higher sensitivity and should be used as first-level imaging in most patients.

Utility of a Bedside Pocket-Sized Ultrasound Device to Promptly Manage Abdominal Pain in the Emergency Department

Introduction: Abdominal pain is a frequent reason for Emergency Department (ED) admission; it amounts for around 5–10% of all ED visits. Early assessment should focus on immediately distinguishing cases of acute abdomen that require urgent surgical intervention. The clinical localization of pain is crucial, suggesting an initial evaluation of the origin of the abdominal pain; however, imaging is often required for final diagnosis. Ultrasound (US) represents a rapid imaging modality that is readily available in the ED and does not involve radiation or contrast agent administration. A new generation of portable, battery-powered, low-cost, hand-carried ultrasound devices have become available recently; these devices can provide immediate diagnostic information in patients presenting with abdominal pain in ED.The aim of the study was to demonstrate the diagnostic usefulness of a bedside pocket-sized ultrasound (BPU) device (Vscan from General Electrics) in non-traumatic patients complaining of acute abdominal pain in a tertiary care university hospital in Italy. Methods: Patients with acute non-traumatic abdominal pain presenting in ED were prospectively enrolled and underwent physical examination, traditional imaging and BPU. Results: A total number of 230 patients with acute non-traumatic abdominal pain were enrolled. Overall agreement between routine standard imaging and BPU turned out to be equal for computed tomography (K=0.3) and traditional ultrasound (K=0.29). Receiver operating characteristics curve (ROC) analysis for diagnostic power of the BPU in comparison with traditional US showed an area under the curve of 0.65, sensitivity and specificity of 87.2% and 42.31% respectively. Conclusions: Emergency use of BPU in patients with non-traumatic abdominal pain demonstrated good diagnostic performance when compared to traditional imaging, with the potential advantage of reducing costs and delay in patient final disposition.

CT in the diagnosis of nontraumatic acute abdominal pain: clinical cases

Acute abdominal pain (AAP) is a clinical symptom complex that develops with injuries and acute surgical diseases of the abdominal organs. This condition is one of the most frequent causes of admission of patients to the hospital through the ambulance. Patients with AAP consist of a large and heterogeneous group at the same time due to the etiology and many variations of the clinical picture of this condition. The article presents the results of CT scan of the abdominal cavity and small pelvis in 5 patients with AAP admitted to the S.P. Botkin Moscow City Clinical Hospital emergency department during 2017–2018, without indication of the possible traumatic nature of the pathology. All patients underwent a primary surgeon examination and first-line medical imaging methods such as plane radiography and ultrasound. The selection criterion for inclusion in the search was the need for CT due to the lack of data obtained for diagnosis. Subsequently, the findings of the CT scan were compared with the final diagnosis in the electronic medical file of the patient concerned, to assess the contribution of CT data to the diagnostic process. In a group of 5 patients included in the study, the results of CT were the decisive step in the diagnostic process in 100% of cases. Therefore, the study emphasizes the importance of using CT in patients with AAP. Using this method allows you to complete a diagnostic search as soon as possible from the time the patient enters the hospital, to begin timely treatment.

Spectrum of Diseases in Patients with Non-Traumatic Acute Abdomen.

Introduction: Acute Abdomen is the most common presenting complaints about 20% of all emergency department, due to its varied etiology it poses significant diagnostic challenges for emergency surgeons. The proper management of patients with acute abdominal pain requires a timely decision about the need for surgical operation.&#x0D; Objective: To identify the spectrum of diseases in patients of non-traumatic leading to Acute abdomen, presenting in a surgical unit.&#x0D; Methodology: During Jan 2012 to Dec 2014, this retrospective study conducted at Surgical Department of Muhammad Medical College, all patients presenting with non-traumatic acute abdominal pain were included in this study. Gynecological and urological causes were excluded. The patient diagnosis and management were recorded from the case files and OT registers.&#x0D; Results: During the period, a total of 216 patients presented with non-traumatic acute abdomen; of which there were 145 (67.12%) males and 71 (32.87%) females, with a male to female ratio of 2:1. The highest incidence of acute abdomen 72 (33.33%) was found in patients of 22-32 years age group followed by under 21 years age group i.e. 51 (23.61%) and 33-42 years age group 43 (19.90%). There were 31 (14.35%) cases in 43-52 years and 19 (8.79%) cases in 53-70 years.&#x0D; The most common cause of acute abdomen was acute appendicitis 105 (48.61%) admissions. These patients were mostly young males in twenties. Intestinal obstruction was second cause 45 (20.83%) cases and this affected more commonly the middle-aged persons. Two hundred and seven (95.83 %) patients were treated successfully and discharged home while 5 (2.31 %) left against medical advice, while 4 expired giving a mortality of (1.85) % in patients with gut perforation&#x0D; Conclusion: The most common cause of acute abdomen is acute appendicitis affecting young population mostly. Another common cause is intestinal obstruction and gut perforation. Acute cholecystitis commonly affects the middle aged, post-menopausal women. Hepatic abscess and Pancreatitis are rare cause of acute abdomen in this area.&#x0D; Key Words: Acute abdomen. Non-traumatic Acute appendicitis, Intestinal obstruction.