Nonspecific Abdominal Pain Research Articles

Laparoscopic cholecystectomy in a patient with Kartagener syndrome having multiple cystic arteries: a case report

Introduction and importance: Situs inversus totalis (SIT) is a rare condition that involves transposition of thoracic and abdominal viscera. It is associated with Kartagener syndrome (KS) that comprises a triad of SIT, bronchiectasis, and chronic sinusitis. Considering this anatomical variation, it poses a technical challenge for right-handed surgeons performing laparoscopic cholecystectomy. This is the only case report for a patient having KS presenting for cholelithiasis found to have multiple cystic arteries during surgery. Case presentation: A 55-year-old man with KS, known to have bronchiectasis, presented with nonspecific diffuse upper abdominal pain and positive murphy sign on the left. Biliary colic with cholelithiasis was diagnosed using ultrasound of the abdomen. The patient was admitted to the surgical floor for persistent biliary colic and was planned for laparoscopic cholecystectomy. The cholecystectomy was done by a single right-handed surgeon, and the patient was discharged on the next day. Clinical discussion: The American laparoscopic cholecystectomy technique with reversed mirror-image of routine laparoscopic cholecystectomy port sites was adopted. The operative team including the operating surgeon and camera operator were on the patient’s right side, and the laparoscopic devices with the technician nurse were located on the left side for safer dissection and easier access to the different structures. The procedure was complicated by the Calot triangle anatomy variation along with the presence of three cystic arteries and one cystic duct. The surgery was completed within 50 minutes, a shorter duration compared to other reported cases. Conclusion: Laparoscopic cholecystectomy in patients with SIT is a challenging, technically demanding procedure due to anatomical inversion and structural variations. The surgeon must modify various technical steps to perform this procedure successfully and dissect the gallbladder and its structures. A good knowledge of anatomy and a skillful dissection intraoperatively remain the gold standards for a successful outcome with minimal complications.

Chronic appendicitis misdiagnosed as a periappendiceal orifice polyp: a case report

BackgroundUnlike acute appendicitis, chronic appendicitis is characterized by nonspecific abdominal pain and intermittent course. This may lead to late diagnosis or misdiagnosis, with the possibility of serious complications.Case reportA male patient of Arab origin aged 55 years had a 2-year history of recurrent episodes of mild pain in the right lower quadrant of the abdomen. The episodes were associated with nausea, chills, and abdominal bloating but no vomiting, rectal bleeding, or weight loss. On examination, the patient showed soft and lax abdomen with mild tenderness in the right lower quadrant, with no organomegaly or abdominal masses. Laboratory findings showed normal complete blood count and C-reactive protein. The patient underwent colonoscopy to rule out malignancy, which showed appendiceal orifice polyp that required resection. The computed tomography scan showed an enlarged appendix with multiple intraluminal dense appendicoliths. The largest stone at the appendiceal orifice measured 1.5 cm × 0.9 cm and was partially protruding within the cecal lumen. The diagnosis of chronic appendicitis was confirmed. The patient underwent appendectomy and was asymptomatic a few days after discharge.ConclusionsWe are reporting a patient with chronic appendicitis presented with multiple appendicoliths. The patient was initially misdiagnosed as periappendiceal orifice polyp. The current finding highlights the importance of imaging, especially computed tomography in confirming the diagnosis in patients with atypical appendicitis presentation.

Procedure-related readmissions following endoscopic retrograde cholangiopancreatography in a liver transplant cohort.

Data on post-endoscopic retrograde cholangiopancreatography (ERCP) adverse events and readmission rates in liver transplantation (LT) patients remain scarce. This study determined the 30-day procedure-related readmission rate following ERCP in an LT cohort at an Australian tertiary academic center. All unplanned readmissions within 30 days following ERCP in orthotopic LT patients between December 2012 and August 2021 were retrospectively identified. Demographic data, procedure variables, and readmission characteristics were also collected. Forty-five procedure-related readmissions were identified (3.3%) from a total of 1369 ERCP procedures. This included 33 cases of cholangitis (2.4%), 7 cases of nonspecific abdominal pain (0.5%), 5 cases of mild post-ERCP pancreatitis (0.5%), and 3 cases of bleeding (0.2%). No procedure-related mortality was observed. The procedure-related readmission rate following ERCP in this LT cohort was 3.3%, which is likely lower than comparable studies carried out on the overall population.

WP7.6 - Unplanned Re-admisisons - How are we doing; Phase 1 study

Abstract Introduction 30-day unplanned re-admissions provide an indicator of performance in the NHS Framework. Average readmission rate is around 15 to 17%, however surgical re-admission is less published. Therefore, a study was set up to assess the factors influencing surgical re-admissions in a Tertiary Centre. Methods Retrospective study of prospectively collected data from the tertiary centre database including all ‘Unplanned Re-admissions’(URA) aged >15 years in general surgery between January and December 2022. URA <15 years old and to other surgical specialties were excluded. ANOVA test and descriptive statistics were used to analyse the data. Results 289 (58%) of 498 readmissions were URA with 150 (52%) female and 139 (48%) male. 57 (19%) were aged 15-30 years, 121 (42%) 31-60 years, 109 (38%) 61-90 years and 2 > 90 years (Median age 54 years; p<0.05). 191 (66%) were from ED, 84 (29%) were GP referrals, 10 (3%) from clinics and 4 (2%) transferred from network. 178 (62%) URA were within 10 days of discharge, 72 (25%) between 11-20 days and 39 (13%) > 20 days (p < 0.05). The commonest cause of URA was biliary diseases (n = 40, 14%) followed by lower (n=32, 11%) and upper abdominal pain (n=17, 5%) and nonspecific abdominal pain (n=22, 7%). Other causes included appendicitis (n=8, 3%), pancreatitis (n=8, 3%), post-op complications (n=14, 5%) and obstruction (n=24, 8%). Conclusions URA significantly impacts health care provision and patients’ confidence. An initial study has identified reasons and patterns of re-admissions, the next phase involves analysing specific reasons to mitigate factors leading to URA.

EP160 - A comparison of pre-rotation confidence levels over a year of surgical foundation year one doctors in a busy district general hospital

Abstract Aims Assess the confidence levels of foundation year one (FY1) doctors in managing surgical patients pre-rotation. Identify areas where further support could be given to improve confidence levels. Methods Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one open question. Cohort One (August 2022) were asked to reflect in December 2022. Cohort Two (December 2022) and Cohort 3 (April 2023) were surveyed at the start of their general surgical rotation. Data was initially inputted using Google Docs and analysed in Microsoft Excel. Results 100% (10/10) cohort one, 75% (6/8) cohort two and 100% (10/10) cohort three completed the survey. Pre-rotation confidence levels mostly improved between the first cohort and last cohort. Areas where modal scores were below three in the last cohort were in managing the acutely unwell general surgical patient, managing biliary disease and managing non-specific abdominal pain. Common concerns of FY1 doctors were not being able to contact a senior in theatre and the busyness of the specialty. Most FY1 doctors felt that group teaching would be the preferred method to increase understanding of general surgery. Conclusions Confidence levels were higher in the final cohort. This suggests core skills are picked up in different specialties which are transferrable to aspects of general surgery. Further work needs to be done to target improvement in areas of lower confidence.

Delayed Diagnosis and Late Presentation of Primary Hyperparathyroidism in Somalia: A Case Report and Literature Review

Primary hyperparathyroidism (PHPT) is a rare endocrine disorder characterized by elevated serum calcium levels due to overproduction of parathyroid hormone (PTH). While parathyroid adenomas are the most common cause, they can present diagnostic and management challenges, especially in resource-limited settings. We present the case of a 51-year-old Somali female with a six-year history of generalized weakness, fatigue, and nonspecific abdominal pain. Laboratory investigations revealed elevated PTH levels (231 ng/ml) and hypercalcemia (14 mg/dl), consistent with PHPT. Cervical ultrasound identified a hypoechoic hypervascular solitary lesion suggestive of a parathyroid adenoma. The patient underwent a successful parathyroidectomy, resulting in the normalization of serum calcium levels and symptomatic relief. Histopathological examination confirmed the diagnosis of parathyroid adenoma. This case underscores the importance of early recognition and intervention in PHPT, particularly in underserved regions where healthcare resources may be limited. Efforts to raise awareness, provide training for healthcare workers, and improve access to diagnostic and treatment modalities are crucial in optimizing outcomes for patients with PHPT.

Oncological background of non-specific abdominal pain in children and adolescents – case report of a girl with ovarian teratoma

Abdominal pain in children is a common, atypical symptom. The vast majority of abdominal pain is functional, non-life threatening and does not require extensive diagnostics. However, it should be remembered that the abdominal cavity is one of the most common locations of solid tumours in children. Carefully collected information and physical examination with oncological vigilance allow for the identification of alarming symptoms accompanying abdominal pain. These include: pain waking up from sleep, palpable mass in the abdominal cavity, vomiting, change in the rhythm of bowel movements, weight loss, fever, dysphagia, weakness, anaemia. The article presents a case report of a teenager with ovarian teratoma. It aims to illustrate the pitfalls and diagnostic difficulties associated with determining the causes of abdominal pain in children and adolescents. The discussion also summarises information on the epidemiology, aetiology and clinical symptoms of teratoma.

Case Report: Solid pseudo-papillary tumor of the pancreas

Solid pseudo-papillary tumors (SPT) of the pancreas are rare neoplasms accounting for less than 2% of all pancreatic tumors and primarily affecting young women. They are generally characterized by a clinical and radiological polymorphism. In most cases, complete surgical resection is curative. We report a case of a young woman presenting with a pancreatic tumor revealed through a vague non-specific abdominal pain. The diagnosis was based on the histological examination of the surgically-removed piece.

#1976 Non-IgA mesangial proliferative glomerulonephritis in a patient with IgA deficiency, a case report

Abstract Background and Aims IgA deficiency (IgAD) is the most common primary immunoglobulin deficiency in western countries. This entity is associated with increased risk of other autoimmune diseases. Mesangial proliferative glomerulonephritis (MesPGN) is a histological pattern defined by mesangial cell proliferation and expansion of the extracellular matrix within the mesangium. The clinical presentation can vary, from nephrotic syndrome to isolated hematuria. 30-40% of MesPGN cases are associated with IgA nephropathy. Other common diagnostic entities that present with this pattern include IgM nephropathy, C1q nephropathy or lupus nephritis, as well as Hepatitis B or C virus infection; idiopathic MesPGN is poorly described in the literature. To the best of our knowledge, this is the first report of idiopathic MesPGN associated with IgAD. Results A 17-year old woman with a background of IgAD and occasional episodes of bronchitis in her childhood presented in January 2022 with nonspecific abdominal pain and macroscopic hematuria. She had been suffering these symptoms for the last few weeks, usually after physical exercise. She was normotensive and showed no fever, skin rashes or other symptoms. Laboratory tests revealed normal renal function (serum creatinine 0.65 mg/dL), urinary albumin-to-creatinine ratio of 23.9 mg/g, a 24-h protein excretion ranging from 40 to 240 mg and non-dysmorphic hematuria of up to 51-150 erythrocytes/field. Additional laboratory tests repeatedly showed only low IgA serum levels, with normal ANA, ANCA or complement levels. Renal ultrasound showed both kidneys with normal size and cortical thickness. A CT urogram observed multiple, bilateral, non-obstructive small-sized kidney stones and a persistent nephrogram. Genetic tests were negative for Alport syndrome-related mutations. Additional workup included occult blood in the stool, stool culture, rectal biopsy and colonoscopy, which were all negative. Symptoms persisted during the following 12 months. A kidney biopsy was performed, finding 40 glomeruli with normal optical appearance, none of them sclerosed. Discrete mesangial expansion and cell proliferation was observed, with capillary lumens with occasional congestion but without thrombi or fibrinoid necrosis. Tubules and interstitium showed no sign of sclerosis or fibrosis, with conserved basement membranes and brush borders. In vessels, subintimal fibrosis, hyalinosis or concentric arteriolar hyperplasia or endarteritis were ruled out. Immunofluorescence showed low-intensity, discrete granular C3 mesangial deposits and no deposition of IgA, IgG, IgM, fibrinogen, C4, C1q or albumin. A diagnosis of non-IgA MesPGN was reached. The patient stopped performing intense physical exercise on a regular basis. This translated in hematuria and abdominal pain of much lower intensity. The patient is currently receiving only supportive therapy and maintains a normal renal function, with persistence of microscopic non-dysmorphic hematuria and occasional, low-grade proteinuria as described. Conclusion MesPGN is the most diagnosed form of glomerulonephritis worldwide. However, most cases are associated with granular IgA deposition in the mesangium, which was absent in this case. Idiopathic, non-IgA MesPGN is a much rarer condition that has been considered by some authors as a form focal segmental glomerulosclerosis or minimal change disease, although others believe it to be a separate condition. IgAD has been previously associated with Crohn's disease, which could explain this patient's symptoms. Crohn's disease has also been associated with non-IgA MesPGN in a low number of patients. Nevertheless, no findings in the patient workup were suggestive of Crohn's disease. A capsule endoscopy study will be performed to clearly rule out such diagnosis.

A rare case of congenital right lobar segmental hepatic hypoplasia complicated by portal hypertension: a radiologic perspective

Abstract Background Segmental hypoplasia of liver is an infrequently encountered congenital anomaly which is clinically indolent and detected incidentally on cross sectional imaging or abdominal surgery which can have a myriad of surgical and medical implications. The unique radiological manifestations and associated complications makes it a diagnostically challenging entity. Case presentation We report a case of a middle-aged female presenting with complaints of non-specific abdominal pain for two years in which we reported the presence of segmental hypoplasia of right lobe complicated by development of portal hypertension incidentally detected on ultrasound examination which was followed up and confirmed on cross sectional imaging. Conclusions In this case report, we present a unique instance of congenital segmental hypoplasia of the liver, highlighting the intricacies of its radiological presentation, potential clinical implications, and the challenges associated with its diagnosis. By examining this rare anomaly, we aim to contribute to the growing body of knowledge surrounding hepatic developmental disorders, fostering a deeper understanding of the clinical spectrum, and facilitating improved patient care through enhanced diagnostic awareness.

A Rare Inflammatory Myofibroblastic Tumor of the Spleen: A Case Report.

Inflammatory myofibroblastic tumors (IMTs) are rare, solid, potentially malignant lesions of uncertain etiology. Histologically, IMTs exhibit a combination of lymphocytes and inflammatory cells within a fibroblastic myxoid layer. The diagnosis of IMTs poses a challenge for various medical specialties, including surgeons, pathologists, and oncologists, due to their non-specific clinical presentation. Furthermore, radiologists face difficulties in interpreting computed tomography (CT) or magnetic resonance imaging (MRI) results, which often yield polymorphic and inconclusive findings. Ultimately, histopathologists play a crucial role in reaching a definitive diagnosis based on the tumor's histological characteristics. They are detected in every system of the human body, most commonly in the lungs. Here, we report an uncommon occurrence of IMT in the spleen of a patient with nonspecific abdominal pain. A 56-year-old Caucasian female presented to Konstantopouleio General Hospital of Nea Ionia, Athens, Greece, with abdominal pain and discomfort. The patient had no significant medical history and normal laboratory tests. An abdominal CT revealed a large mass in the spleen. A splenectomy was performed. Histopathological analysis of the tumor revealed IMTS. Splenic IMT is a rare benign tumor with moderate malignant potential. It lacks a distinct clinical presentation and is typically identified either incidentally or during the examination of abdominal pain.

Retroperitoneal Rectal Perforation Due to Pomegranate Seed Bezoar: A Rare Case

Various causes are involved in rectal perforation aetiology, including: Iatrogenic perforations, traumatic perforations, malignant or diverticular disease perforations, stercoral perforations, and idiopathic perforations. Rectosigmoid perforations are life-threatening and require immediate diagnosis and surgical treatment. Bezoars are accumulations of indigestible foreign matter that accumulate in the gastrointestinal tract. Seed vesicles are a subset of phytobizzars produced by plant seeds or undigested fruit kernels. Most Intestinal bezoura occur in the rectum, causing constipation or nonspecific abdominal or rectal pain. The following is a report of a case of pomegranate seeds in the rectum that resulted in retroperitoneal rectal perforation.

Twist in the Bowel: A Multimodality Radiological Imaging Spectrum.

Volvulus affecting the gastrointestinal (GI) tract is one of the common causes of recurrent pain in the abdomen, and often, patients present with non-specific abdominal pain associated with nausea and/or vomiting. A high degree of suspicion is required at the clinician's end to suspect this diagnosis, which is usually confirmed by imaging using radiographs, fluoroscopic evaluation, and computed tomography. Familiarity of the clinician and radiologist with the imaging appearances of these emergent conditions on various imaging modalities is quintessential to avoiding life-threatening complications like bowel ischemia or perforation, which are associated with delayed or missed diagnosis. Our article describes the clinical features and classical imaging of the various types of volvulus affecting different bowel segments in the entire GI tract.

Validation of the Appendicitis Inflammatory Response (AIR) score during pregnancy: A nested case-control study.

Appendicitis poses diagnostic challenges. A correct diagnosis is important during pregnancy to avoid unnecessary surgery on the one hand and delayed surgery on the other hand, as both may negatively affect pregnancy outcomes. Clinical scores for risk-stratified management of suspected appendicitis are well established in adults but have not been validated during pregnancy. This nested case-control study evaluated the diagnostic accuracy of the Appendicitis Inflammatory Response (AIR) score and imaging during pregnancy. By cross-linking national Swedish health registries from a defined geographical area, we identified a cohort of 154 women who underwent appendectomy for suspected appendicitis during pregnancy and a matched cohort of 232 pregnant women admitted for acute abdominal pain and suspected appendicitis but with a discharge diagnosis of nonspecific abdominal pain (NSAP). All variables were extracted from medical records. The diagnostic value of AIR score and imaging was estimated for patients with a final diagnosis of appendicitis compared with patients with negative appendectomy and NSAP patients. The final diagnoses for the operated patients were uncomplicated and complicated appendicitis in 49.4% and 26.6%, respectively, and negative appendectomy in 24.0%. Nearly half of all the patients underwent diagnostic imaging (41%), mainly by ultrasonography. The sensitivity and specificity of diagnostic imaging were 44.9% (95% CI 32.9%-57.4%) and 42.2% (95% CI 31.9%-53.1%), respectively. The area under the receiver operating characteristic curve of AIR score was 0.88 (95% CI 0.84-0.92) for all appendicitis and 0.90 (95% CI 0.84-0.95) for complicated appendicitis. The sensitivity for complicated appendicitis was 100% at a score of ≥4. The specificity for all appendicitis was 97% at a score of ≥9. The results of this study suggest that the AIR score may be a suitable diagnostic tool for risk stratification of pregnant women with abdominal pain and suspected appendicitis but further validation among pregnant women is needed.

Abdominal involvement as a primary manifestation of systemic or isolated gastrointestinal vasculitis

Systemic vasculitides can cause a wide variety of gastrointestinal manifestations (GI) ranging from mild and frequently nonspecific abdominal pains to potentially life-threatening bowel perforations. Vascular involvement in systemic vasculitides can affect any GI blood vessel, most commonly mesenteric, hepatic, or splenic arteries. Inflammatory changes affecting different layers of arterial vessel walls can lead to aneurysmatic dilatation or blood vessel occlusion with subsequent organ ischemia leading to mucosal ulcerations, GI bleeding, perforations, or bowel obstruction. While the presence of extraintestinal manifestations may aid in diagnosis, delays in making appropriate diagnoses and rapid initiation of glucocorticoid and immunosuppressive treatment can have detrimental consequences. Awareness of isolated gastrointestinal vasculitis is of particular importance as it frequently remains undiagnosed until end-stage organ damage becomes apparent. Vasculitis mimics such as vascular Ehlers-Danlos syndrome or fibromuscular dysplasia add another lay of complexity in approaching patients with suspected GI vasculitis and should always be carefully considered.

Unraveling the Enigma: Omental Torsion in a Patient with Non-specific Abdominal Pain

Omental torsion is a rare cause of acute abdominal pain, with an incidence rate of less than 0.37%. Due to its non-specific symptoms, it is often confused with other causes of acute abdominal pain, such as acute appendicitis. In this case presentation, we will discuss a 26-year-old male patient who presented to the emergency department with complaints of abdominal pain and was diagnosed with perioperative omental torsion. The diagnosis of omental torsion is challenging due to its non-specific symptoms. When a diagnosis cannot be established in acute pain, diagnostic laparoscopy should not be delayed. Omental torsion can be easily treated with laparoscopic omentectomy.

Community Emergency Care Use by Veterans in an Era of Expanding Choice

Recently passed legislation aimed at improving access to care has considerably expanded options for veterans to receive emergency care in community, or non-Veterans Affairs (VA) settings. However, national trends in community emergency department (ED) use by veterans are unknown. To examine national, temporal trends in the frequencies and types of ED visits provided in community settings and explore the association between facilities' purchase of community care with facility and regional characteristics. Retrospective, observational cross-sectional study of ED visits over fiscal years (FY) 2016 to 2022. VA and community ED encounter data were obtained from the VA Corporate Data Warehouse and the Office of Integrated Veteran Care. Participants were veterans receiving ED care at VA facilities or paid for by the VA in the community. Data were analyzed from June to September 2023. The primary outcome measures included community ED visit volume, disposition, and payments over time. Also, the most common and costly ED visits were assessed. Negative binomial regression analysis examined associations between facility and regional characteristics and the rate of ED visits purchased in community settings relative to all ED visits. There were 19 787 056 ED visits, predominantly at VA facilities (14 532 261 visits [73.4%]), made by 3 972 503 unique veterans from FY 2016 to 2022. The majority of ED users were male (3 576 120 individuals [90.0%]), and the median (IQR) age was 63 (48-73) years. The proportion of community ED visits increased in absolute terms from 18% in FY 2016 to 37% in FY 2022. Total community ED payments, adjusted to 2021 dollars, were $1.18 billion in FY 2016 and over $6.14 billion in FY 2022. The most common reasons for ED visits in the community were for nonspecific chest pain (305 082 visits [6%]), abdominal pain (174 836 visits [3%]), and septicemia (149 968 visits [3%]). The average proportion of ED visits purchased by a VA facility increased from 14% in FY 2016 to 32% by FY 2022. In multivariable analyses, facilities with greater ED volume and low-complexity facilities had higher expected rates of community emergency care than lower volume and high-complexity facilities, respectively. As veterans increasingly use community EDs for acute, unscheduled needs, attention to factors associated with veterans' use of acute care services in different settings are important to identify access barriers and to ensure veterans' health care needs are met.

Retroperitoneal hernia following laparoscopic living-donor nephrectomy: a case report and review of literature

BackgroundThe laparoscopic approach is the standard of care for living-donor nephrectomy. A rare postoperative complication is small bowel obstruction due to a retroperitoneal hernia. We present a case of an incidental finding of a retroperitoneal hernia in a patient with a history of laparoscopic donor nephrectomy.Case presentationAn adult male presented with diffuse abdominal pain, vomiting, and obstipation for 12 h. He had undergone laparoscopic donor nephrectomy two months prior. Plain abdominal radiograph revealed a dilated small bowel with homogenous opacity in the left lumbar region. Due to worsening diffuse abdominal pain and a high clinical suspicion of intestinal strangulation and ischemia after conservative management, an exploratory laparotomy was performed. Intraoperatively, an incarcerated small bowel segment herniating through an 8 cm descending mesocolon defect into the retroperitoneal space was discovered, forming a closed-loop obstruction. The bowel segment was reduced, and the mesocolon defect was repaired. The patient was discharged five days postoperatively with good recovery.ConclusionRetroperitoneal hernia following laparoscopic living-donor nephrectomy is a rare but significant complication. Mitigation to prevent mesenteric defect creation, routine inspection, and closure of the defect can reduce the risk of hernia. Non-specific abdominal pain in patients with a history of laparoscopic donor nephrectomy prompts rapid imaging evaluation to aid in the early diagnosis of possible retroperitoneal hernia and its intervention.

Silent neuroendocrine tumor of biliary confluence

Neuroendocrine tumors (NETs) of the extrahepatic bile ducts are extremely rare. They are heterogeneous entities of varied histopathological features. The pathological types vary greatly with regards to biological behavior and prognosis. We presented such a case of silent tumor of the biliary tract of neuroendocrine origin in a middle-aged female with nonspecific abdominal pain without any clinically obvious signs which on radiological imaging revealed a tumor of hepatic confluence with metastatic deposits in liver for which she underwent left trisectionectomy with segment 7 metastatectomy. As per the literature reviews regarding extrahepatic bile duct NET these tumors are more common in the middle age population with a female preponderance. The tumors were symptomatic in majority of patients and the symptoms are mostly related to tumor mass and its invasion of adjacent structures or metastases rather than hormone and vasoactive peptide secretions. The low incidence and uncommon modes of presentation makes the diagnosis tough and management challenging.

Impact of emergency physician performed ultrasound in the evaluation of adult patients with acute abdominal pain: a prospective randomized bicentric trial

BackgroundAbdominal pain is common in patients visiting the emergency department (ED). The aim of this study was to assess the diagnostic contribution of point-of-care ultrasound (POCUS) in patients presenting to the ED with acute abdominal pain.MethodsWe designed an interventional randomized, controlled, open label, parallel-group, trial in two French EDs. We included adult patients presenting to the ED with acute abdominal pain. Exclusion criteria were a documented end-of-life, an immediate need of life-support therapy and pregnant or breast-feeding women. Patients were randomized in the experimental group (i.e., workup including POCUS) or control group (usual care). The primary objective of the study was to assess the added value of POCUS on diagnostic pathway in the ED, according to the diagnostic established a posteriori by an adjudication committee. The primary endpoint was the proportion of exact preliminary diagnosis between the 2 groups. The preliminary diagnosis made after clinical examination and biological results with POCUS (intervention arm) or without POCUS (usual care) was considered exact if it was similar to the adjudication committee diagnosis.ResultsBetween June 2021 11th and June 2022 23th, 256 patients were randomized, but five were not included in the primary analysis, leaving 125 patients in the POCUS group and 126 patients in the usual care group (130 women and 121 men, median [Q1-Q3] age: 42 [30;57]). There was no difference for exact diagnosis between the two groups (POCUS 70/125, 56% versus control 78/126 (62%), RD 1.23 [95% CI 0.74–2.04]). There was no difference in the accuracy for the diagnosis of non-specific abdominal pain nor number of biological or radiological exams. Diagnostic delays and length of stay in the ED were also similar.ConclusionsIn this trial, systematic POCUS did not improve the rate of diagnostic accuracy in unselected patients presenting to the ED with acute abdominal pain. However, as it was a safe procedure, further research should focus on patients with suspected etiologies where POCUS is particularly useful.Trial registration: This trial was registered on ClinicalTrials.gov on 2022/07/20 (https://clinicaltrials.gov/study/NCT04912206?id=NCT04912206&rank=1) (NCT04912206).