Non-traumatic Acute Abdomen Research Articles

Fixed Rate vs Fixed Injection Duration In Single-Pass Contrast-Enhanced Abdominal Multi-Detector CT: Effects On Vascular Enhancement.

To evaluate the effects on vascular enhancement of either a fixed rate (FR) or a fixed injection duration (FID) in single-pass (SP) contrast-enhanced abdominal multi-detector CT (CE-MDCT). Ninety-nine (54M; 45F; aged 18-86 yrs) patients with nontraumatic acute abdomen underwent a SP CE-MDCT after i.v. injection of 1.7 cc/Kg of a nonionic iodinated contrast-media (370 mgI/ml) performed with either a FR (2 cc/sec; Group A) or a FID (55 sec; Group B). In both groups, patients were further stratified according to total body weight (Kg) as follows: 40-60 (L); 61-80 (M); 81-100 (H). Signal- (SNR) and contrast-to-noise ratios (CNR) were calculated for the liver and for both abdominal aorta (AA) and main portal vein (MPV). Statistical analysis was performed by Student's T or Chi-square test for continuous and categorical data, respectively, whereas post-hoc analysis was performed by the Mann-Whitney test (p < 0.05). There were no significant differences in demographic and physical characteristics between Group A (n = 50; 53 ± 20 yrs; BMI = 23.4 ± 4.4) and B (n = 50; 51 ± 17 yrs; BMI 22.7 ± 4.2). Whereas overlapping findings were observed in the M sub-groups (n = 40), SNR and CNR were significantly higher (p < 0.01) in Group B for both AA and MPV in the high (H) weight sub-groups (n = 20) while not significant differences were observed in the low (L) weight sub-groups (n = 40) despite a significantly lower injection rate (1.6 ± 0.2 cc/sec, p < 0.01) in Group B. A FID results in an overall better vascular enhancement than a FR in SP CE-MDCT.

Value of Imaging in the Non-traumatic Acute Abdomen of Elderly Patients

Value of Imaging in the Non-traumatic Acute Abdomen of Elderly Patients

Is night emergency laparoscopy a high-risk surgery?

Introduction: Although laparoscopy has become the gold standard for many abdominal emergency pathologies, emergency nighttime laparoscopic surgery is considered high-risk for several reasons, particularly due to limited resources in the operating room during nighttime hours. The primary objective of our study is to evaluate the feasibility and safety of nighttime laparoscopy in the management of non-traumatic acute abdomen. Materials and Methods: Descriptive and prospective, evaluative study conducted between February 2018 and October 2021. Our study included 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies. Results: Among the 337 patients, we operated on 211 patients (62.6%) outside of regular working hours (between 4:00 PM and 8:00 AM), of which 189 patients (56.10%) were operated on from 4:00 PM to 12:00 AM, and 22 patients (6.2%) from 12:00 AM to 8:00 AM. The mean operative time was 52.09 ± 24.14 minutes. Perioperative difficulties related to the operated pathology were encountered in 21 cases (9.95%). The overall mean hospital stay was 1 day (range: 7 hours - 4 days). We compared nighttime laparoscopy with daytime laparoscopy and found an advantage in favor of nighttime laparoscopy in reducing hospitalization duration (p value 0.003). Conclusion: Nighttime laparoscopy is feasible and safe.

Post-operative site infections among surgical patients at Southern Ethiopia: A prospective cohort study

ObjectiveThe current study was conducted to estimate the magnitude of SSI among surgically treated patients and identify the predictors associated with it. Backgroundsummary: Despite the fact that surgical site infection (SSI) is still a global health care-associated infection related to patients' discomfort, morbidity, and mortality, it is the most preventable nosocomial infection if all necessary measures are taken into account. MethodsAn institution-based prospective cohort study was conducted at a large teaching hospital in southern Ethiopia. Patients admitted to the surgical ward with a non-traumatic acute abdomen were participants in the study and were followed prospectively for 30 days. The collected data was entered into Epi-Data 4 and exported to STATA 16 for analysis. A logistic regression (bi-variable and multivariable) model was computed to detect the association between SSI and predictors. In the final model, variables with a p-value <0.05 were declared statistically significant. ResultsIn this study, a total of 169 patients were enrolled. More than 3/4th (78.9%) of them were male, and the mean ± SD age of participants was 42.14 ± 12.5 years. Eighteen participants (10.5%) suffered from surgical site infection (SSI). Predictors of SSI were ever smoking [AOR = 3.9; 95% CI (1.2–16.5)], American Society of Anesthesiologists score ≥3 [AOR = 8.9; 95% CI (1.7–45.5)], appendectomy [AOR = 7.7; 95% CI (1.3–45.7)], and co-morbid diabetes [AOR = 13.8; 95% CI (2.6–72.1)]. ConclusionThe magnitude of SSI was considerable in the study setting. Predictors of SSI were smoking, ASA score, appendectomy, and co-morbid diabetes. We strongly recommend that health-care professionals provide health education and patient counseling on smoking and health-seeking behaviors. Considering co-morbid conditions before surgery has paramount importance. Moreover, further large-scale studies are suggested.

Evaluation of Acute Abdomen by Multidetector Computed Tomography: A Prospective Study in a Tertiary Care Hospital in Andhra Pradesh, India

Abstract Background and Objective: Evidence on the efficiency of multidetector computed tomography (MDCT) in diagnosing acute abdomen in the Indian setting is lacking. This study was conducted to estimate the incidence of various causes of acute abdomen, correlate MDCT observations with postoperative findings, and estimate the sensitivity and specificity of MDCT findings. Methods: In this prospective study, 54 patients with acute abdomen were recruited in the emergency department (ED) of a tertiary care hospital in Chittoor, India. In these patients, MDCT observations were compared with postoperative findings, and the sensitivity and specificity of MDCT findings were estimated. Results: The majority of the patients presented with pain in epigastrium (n = 13, 24.1%), and 46 (85.2%) had nontraumatic acute abdomen. Pancreatitis was the major cause of nontraumatic acute abdomen. MDCT had failed to detect one case of acute appendicitis, one calculous cholecystitis, Meckel’s diverticulum, stricture ureter, and degloving injury of the colon. Overall, MDCT was positive for 57 out of a total of 63 conditions (eight patients had two different diagnoses) and it could rule out acute abdomen accurately in one patient. The sensitivity of MDCT in diagnosing acute abdomen was 92% and specificity was 100%. Conclusion: MDCT is a valuable diagnostic radiological investigation for patients with acute abdomen presenting to the EDs. Its multiple advantages put it ahead of the other traditional radiological investigations.

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 &gt;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.

Treatment Outcomes of Non-Traumatic Acute Abdomen and Its Associated Factors in Adult Patients at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia: Cross-Sectional Study

Treatment Outcomes of Non-Traumatic Acute Abdomen and Its Associated Factors in Adult Patients at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia: Cross-Sectional Study

Ultrasonographic evaluation of common findings in acute abdomen amongst paediatric age group in Kano Metropolis, Nigeria

Acute abdomen is very common complaint for paediatric patients presenting to the paediatric emergency departments and outpatient clinics and its management is time consuming. Ultrasound is reliable for the diagnosis of acute abdomen. This study was aimed at evaluating the commonest ultrasonographic findings in paediatric age group presented with acute abdomen in Kano metropolis, Nigeria. This was rospective, cross sectional study conducted from September, 2020 to December, 2022. A convenience sampling method was employed and a sample size of 170 paediatric patients with ages ranging between 0 and 18 years. Paediatrics presenting with non-traumatic acute abdomen were included in the study, while those with traumatic acute abdomen were excluded. GE LOGIQ F6 US machine with transducer frequency of 3.5 MHz-8 MHz was used as an instrument for data collection. The selected patients were scanned in supine position. Data generated was analyzed using SPSS version 22.0. Results generated indicate that the commonest symptoms of acute abdomen among paediatric in Kano metropolis besides abdominal pain were vomiting (63.5%) and running fever (55.8%). The commonest ultrasonographic findings of acute abdomen were gastroenteritis (17.1%), acute appendicitis (12.9%), nonspecific abdominal pain (10.0%) mesenteric adenitis (7.6%) and acute cholecystitis (7.1%). Intussusception, intestinal obstruction and intestinal perforation accounted for 5.9% each. Pyelonephritis, and cystitis accounted for 4.1% and 4.7% respectively. There was 2.9% for each acute hepatitis, renal calculus and pelvic inflammatory disease (PID). Midgut malrotation and volvulus and acute peritonitis accounted for 1.8% each. The common findings in acute abdomen among paediatrics in Kano metropolis, Nigeria were gastroenteritis, acute appendicitis, nonspecific abdominal pain and mesenteric adenitis.

A Qualitative Study of the Triage of Patients with Non-Traumatic Acute Abdomen

Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate; the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.

Role of USG and Plain Radiograph in Non-Traumatic Acute Abdomen

Role of USG and Plain Radiograph in Non-Traumatic Acute Abdomen

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 &amp;amp; Liu, Pepe &amp;amp; Thompson, Pepe, Cai &amp;amp; Langton, and Todor &amp;amp; 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.

Clinical Presentations and Operative Management of Non Traumatic Acute Pain Abdomen- A Prospective Interventional Study from Jorhat, Assam, India

Introduction: Non traumatic acute abdominal pain is a very common reason for patients’ visit to the Emergency Department and remains a challenging task for general surgeons in terms of appropriate diagnosis as well as management in a timely manner. Aim: To evaluate the clinical presentations, the operative management and the post-operative outcome of patients presented with non-traumatic acute pain abdomen. Materials and Methods: A hospital-based prospective interventional study was done in 250 patients presenting with non-traumatic acute pain abdomen to the Emergency Department of General Surgery, Jorhat Medical College and Hospital, Jorhat, Assam, India, from June 2021 to May 2022. Demographic profile, detailed history physical examination, operative managements and the outcome were noted. Results: Out of 250 patients with non-traumatic acute pain abdomen who underwent operative intervention, most affected age group was 2nd-4th decade of life, comprising 165 (66%) patients. A total of 167 (66.80%) were males. Most common presenting symptom besides pain abdomen was nausea, seen in 172 (68.80%) cases. Most common clinical sign besides tenderness was abdominal muscle guarding, seen in 220 (88%) cases. Acute appendicitis was the most common aetiology with 129 (51.60%) patients and emergency open appendicectomy was the most common surgical procedure performed. Most common post-operative complication was surgical site infection, seen in 57 (22.80%) cases. Mortality rate was 3.60% (9 deaths). Conclusion: As most acute pain abdomen invariably present with surgical emergency and varied aetiology, the complexity for imparting the most appropriate treatment is increased. Hence, surgeons in the emergency department need to be wellversed in assessing the patients right from taking of proper history, clinical correlation of symptoms to elicitation of signs, assisted with most readily available investigations, to arrive at a prompt diagnosis to provide appropriate surgical intervention at the earliest.

Comparative study between clinical diagnosis, plain radiography and sonography for the diagnosis of nontraumatic acute abdomen.

Acute abdomen is the most commonly attended surgical emergency. It can be caused by intra-abdominal, extra-abdominal and metabolic causes. A few imaging modalities are at disposal of primary care physicians like plain x-ray and ultrasonography. This study has been done to compare the efficacy of clinical diagnosis, plain radiography and sonography in diagnosis of non-traumatic acute abdomen. Every patient under study admitted in the Department of General Surgery underwent thorough clinical evaluation, biochemical investigations, X-rays and sonography. Findings of clinical evaluation, X-Rays and sonography were compared to the final diagnosis found intraoperatively. Clinical diagnosis was made in 47 (94%) out of 50 patients. X-rays were able to diagnose in 20 patients (40%) whereas sonography diagnosed 26 patients (52%). The present study showed that clinical evaluation, x-rays or Ultrasound alone are not sufficient to diagnose cause of non-traumatic acute abdomen in all cases. Clinical evaluation combined with x-rays and ultrasound increases the number and accuracy of pre-operative diagnosis in non-traumatic acute abdomen.

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 &amp; 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.

A Comparative Analysis of Pre Operative and Operative Findings in Non Traumatic Acute Abdomen: A Prospective Observational Study

Acute abdomen remains the important cause of morbidity and mortality in emergency. It requires careful history taking and thorough evaluation of symptoms, clinical examination and judicious use of radiological investigation which simplify the evaluation of disease. Aim and Objectives: To assess the accuracy of radiological diagnosis in comparison to postoperative diagnosis in non-traumatic cases of acute abdomen. Materials and Method: A prospective observational study of non-traumatic acute abdomen was carried out at Sahyadri Narayana Multispeciality Hospital, Shimoga, Karnataka. Total of 78 cases of acute abdomen patients were evaluated and operated over a period from December 2018 to February 2020 and included in the study group. Pediatric age group (12 years and below), traumatic cases (blunt and penetrating), acute abdomen in pregnancy and gynecological causes of acute abdomen, urological cases, and conservatively managed cases were excluded from the study. Detailed history was taken and relevant physical examination performed. All patients underwent hematological and biochemical investigations, appropriate radiological investigation (USG, AXR and CT-scan) were performed based on clinical suspicion. Clinical and radiological diagnosis based on clinical examinations and radiological investigations was compared with post-operative diagnosis based on operative findings. Result: The most common age group was 20-60 years with male preponderance. Pain in abdomen was commonest symptom followed by vomiting, anorexia and fever. Tenderness was commonest clinical sign observed followed by rebound tenderness, tachycardia and guarding/rigidity. Acute appendicitis was the most common cause of acute abdomen followed by perforation peritonitis and intestinal obstruction. The overall diagnostic accuracy of clinical examination in acute abdomen was 81.8% and if radiological imaging techniques combined with this, the accuracy raised up to 94%. Conclusion: The study strongly suggested that with thorough history taking and proper clinical examination, clinical diagnosis was successfully achieved in 82% of patients. Radiological investigations help in confirming clinical suspicions and giving added information of underlying pathology with accuracy of 94%. Keywords: Abdomen Injury; Radiological Investigations; Trauma; Diagnostic Test; Perforation.

CT study protocol optimization in acute non-traumatic abdominal settings.

Abdominal acute pain is a manifestation of heterogeneous medical conditions, with difficult clinical-laboratory assessment. Multi-detector CT (MDCT) is the gold standard imaging technique for evaluating adult patients with acute abdominal pain. Due to its fast execution and the high spatial resolution, CT is fundamental in the diagnostic and therapeutic work-up of patients with time-dependent pathology that could require surgical treatment, reducing mortality and morbidity. However, the radiological risk connected to the ionizing radiation use should not be underestimated, especially in young patients. The aim of this study is to identify optimized CT protocols to apply in the management of non-traumatic acute abdomen. In particular, this review is focused on the main emergency settings: acute pancreatitis, small bowel obstruction, acute appendicitis and acute diverticulitis. This survey would not be complete without mentioning Dual-Energy CT (DECT) technique, one of the last frontiers in CT, achieving encouraging results also in acute abdominal conditions.

Tracer indicators in patients with acute surgical abdomen

Introduction: The tracer indicators are elements to be taken into account by the surgical services to know the morbidity and mortality in the non-traumatic acute abdomen. Objective: To describe the characteristics of tracer diseases in the non-traumatic acute abdomen in the General Surgery service of the Manuel Ascunce Domenech University Hospital in Camagüey. Methodological design: A cross-sectional longitudinal descriptive observational study was carried out in 657 patients. The data came from the medical records and were processed using descriptive statistics, relating some variables in a non-inferential way. Results: 60.6% of the patients were men. 30.7% were between 40 and 59 years old. There were 334 patients with symptom evolution time between 24-47 hours. 42.5% presented acute appendicitis. There were 29.2% complications, 66.1% of them were infectious. Mortality was 10.2%. 37.3% of the deceased presented pulmonary thromboembolism, 50.7% presented intestinal occlusion. The reoperation and readmission rates were 5.3% and 7.6%, respectively. Conclusions: The study of tracer diseases shows that: Almost a tenth of the patients died, being pulmonary thromboembolism the cause of the deaths. The time of evolution greater than 24 hours, infectious complications, ages over 40 years and intestinal occlusion as a cause of acute abdomen seemed to influence the mortality of the sample studied. Evisceration and infection of the operative site were the causes of admissions and reoperations.

Clinical-epidemiological changes in patients with non-traumatic acute abdomen during the COVID-19 pandemic: a retrospective study.

we intend to demonstrate the clinical alterations and the postoperative evolution in patients with acute abdomen non-traumatic in conservative or surgical treatment during the pandemic compared to a similar period in the last year. a single-center retrospective study, including patients who received clinical-surgical treatment at Hospital do Trabalhador diagnosed with acute abdomen between March and August 2020 and a similar period in 2019.Variables studied ranged from demographic data to indices of social isolation. 515 patients were included, 291 received treatment in a pre-pandemic period and 224 during. There was not statistical difference in relation to comorbidities (p=0.0685), time to diagnosis and seeking medical help. No statistical differences were observed in terms of days of hospitalization (p = 0.4738) and ICU need (p=0.2320). Regarding in-hospital deaths, there was statistical relevance in the age above 60 years (p=0.002) and there were more deaths during the pandemic period (p=0.032). However, when we analyze the factors associated with the number of days until diagnosis by a physician, there was no statistical difference. the analyzed data showed that the pandemic period and age over 60 years were the variables that increased the odds ratio for the in-hospital death outcome. However, the length of stay, days in intensive care unit and postoperative surgical complications showed no significant difference.

Effectiveness of D-dimer, CRP, procalcitonin and white blood cell count in non-traumatic acute abdomen

Effectiveness of D-dimer, CRP, procalcitonin and white blood cell count in non-traumatic acute abdomen

Virtual Noncontrast Images Derived From Contrast-Enhanced Dual-Layer Spectral Abdominal Computed Tomography: A Pilot Study Between Pediatric and Adult Scans.

We aimed to compare the accuracy of virtual noncontrast (VNC) images obtained from contrast-enhanced dual-layer spectral computed tomography (DLSCT) scans of the abdomen between pediatric and adult patients. We retrospectively studied 10 pediatric and 40 adult patients who underwent unenhanced and contrast-enhanced DLSCT for nontraumatic acute abdomen or a follow-up of tumor or aneurysm. On true noncontrast (TNC) and VNC images, we placed a region-of-interest on 7 abdominal structures. The mean attenuation difference between VNC and TNC images was compared between these structures and between pediatric and adult scans. Data were analyzed by using the Wilcoxon signed-rank test, 1-way analysis of variance, Scheffe's test and independent t test. A P value less than 0.05 was considered statistically significant. In mean attenuation difference between VNC and TNC images, there was a significant interstructure difference in adult scans (P < 0.05), but not in pediatric scans. Mean attenuation difference between VNC and TNC images of the kidney was significantly higher on adult than pediatric scans (P = 0.0046). The VNC images obtained from contrast-enhanced DLSCT data may be more accurate on pediatric than adult scans. Patient age can be a factor influencing the accuracy of the VNC images.