Non-traumatic Acute Abdomen Research Articles

Outcome of Non-Traumatic Surgical Acute Abdomen in Nekemte Referral Hospital Southwest Ethiopia: A Retrospective Cross-Sectional Study

Background: Acute abdomen is an acute onset of abdominal disease entities that require immediate surgical intervention in most of the cases. The causes of non-traumatic surgical acute and their relative incidence varies in different populations. Objective: To determine the magnitude and the common causes as well presenting features and the outcome of non-traumatic surgical acute abdomen (In Nekemte Referral Hospital, Oromia region, Ethiopia). Methods: A retrospective cross sectional study was conducted using data available at Nekemte Referral Hospital from January 2011 to December 2013. We examined 295 records of the patients from the medical records. Data were collected using checklist based on registration books. The data were entered and analyzed using SPSS version 20.0 statistical package. The association between the independent and dependent variable was assessed by bivariate and multivariate regression analyses. A 95% CI and p-value of ≤0.05 were used to determine independent predictors of outcome of non-traumatic surgical acute abdomen. Results: Out of 295 patients, 230 were males and 65 were females. The age ranged from 6 months to 80 years with a mean age of 33.7 ± 18.6 years. Out of 295, 57.6% was rural and 46.4% were urban dwellers. The most common cause of acute abdomen was acute appendicitis 140(47.4%) followed by bowl obstruction 118(40.0%). Age, Residence, Duration of illness and length of hospital stays are independent predictors of management outcomes of non-Traumatic acute abdomen. Conclusion: Complications were more in cases from rural area due to delay at presentation and no operation facility and surgeons for solutions.

Estimation of the capacity of emergency surgery in Konya: Nine-year multicenter study.

Although the number of surgical emergencies continues to increase, comprehensive data on emergency surgical admissions are scarce. The aim of this multicenter study was to evaluate the causes, management, and outcomes of the general surgical emergencies in the city of Konya, Turkey. The relevant details of the cases admitted and considered to be general surgical emergencies in Konya over a nine-year period (January 2003-January 2012) were analyzed. All demographic data were analyzed statistically. The study group comprised 21954 cases from 4 hospitals in Konya: 7154 from Konya Numune Hospital, 6,654 from Konya Education and Research Hospital, 6,400 from Necmettin Erbakan University Meram Medical Faculty, and 1,390 from Başkent University Konya Education and Research Hospital. Their mean age was 59.6 years, and the average hospitalization time was 3.3 days. The diagnoses of the admitted patients were as follows: acute appendicitis (59.57%), bowel obstruction (11.12%), trauma (7.97%), strangulated inguinal hernia (5.46%), acute cholecystitis (4.87%), peptic ulcer perforation (4.09%), mesenteric ischemia (2.73%), necrotizing fasciitis (2.73%), gastrointestinal system bleeding (1.79%), and others (1.1%). The findings of the study indicate a steady increase in surgical admissions to emergency units. Non-traumatic acute abdomen was the most common reason for general surgical emergencies. Although the number of elderly patients increased, the hospital stay and mortality rates decreased over the study period.

A prospective study of epidemiology and clinical presentation of non-traumatic acute abdomen cases in a tertiary care hospital of central India

Background:Acute Abdomen is a term used to encompass a spectrum of surgical, medical and gynecological conditions ranging from trivial to life threatening conditions, which require hospital admission, investigations and treatment. The purpose of this study was to identify the epidemiological pattern and to determine the spectrum of disease causing “non-traumatic acute abdomen in central India”.Methods: This is a prospective study of 98 patients of non-traumatic acute abdominal cases conducted in the Department of Surgery, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India. In this study, preoperative detailed history and thorough physical examination was done for all acute abdominal emergencies, to arrive at pre-operative diagnosis.Results:Amongst the study of 98 patients, males have higher incidence of acute abdomen with the young age group (21-30 years) most commonly affected. Perforation peritonitis constituted the most common cause of acute abdomen (39.7%), followed by acute appendicitis (37.7%), followed by intestinal obstruction (14.2%).Conclusions: This study was conducted to evaluate the epidemiology, etiology and differential diagnosis of non-traumatic acute abdomen. At the end of the study, we had a better insight of the spectrum of the condition and we concluded that there is more scope for further work in the same field for better understanding of this topic.

Negative laparotomy rates in acute abdomen: a declining trend

Background:A prospective observational study of 105 operated cases of non-traumatic acute abdomen in emergency setting in tertiary government hospital was carried out. The correlation between preoperative diagnostic, radiological and clinical assessment and operative findings was noted. The clinical and radiological diagnostic accuracy rates were calculated using descriptive statistical analysis. Negative laparotomy rates were calculated and compared to the previous studies.Methods: The most common finding was acute appendicitis and the most frequently involved age group was 21-40.The absence of correlation between preoperative diagnosis and operative findings was noted in 7 cases of which 2 cases of appendicitis had been missed on ultrasound and 2 cases of appendicular mass were reported as acute appendicitis where appendectomy could not be done on account of adhesions.2 cases of x-ray diagnosed obstruction with clinical features of vomiting ,constipation had no gross bowel pathology on laparotomy while one case diagnosed preoperatively as appendicitis turned out to be a case of renal colic with hydroureter.Results:The diagnostic accuracy rate of x-ray and ultrasound for obstruction/perforation and acute appendicitis were found to be 89.79% and 94.64% respectively.Conclusions:The negative laparotomy rates were low around 2.85%.

Do C-reactive protein level, white blood cell count, and pain location guide the selection of patients for computed tomography imaging in non-traumatic acute abdomen?

The value of abdominal computed tomography in non-traumatic abdominal pain has been well established. On the other hand, to manage computed tomography, appropriateness has become more of an issue as a result of the concomitant increase in patient radiation exposure with increased computed tomography use. The purpose of this study was to investigate whether C-reactive protein, white blood cell count, and pain location may guide the selection of patients for computed tomography in non-traumatic acute abdomen. Patients presenting with acute abdomen to the emergency department over a 12-month period and who subsequently underwent computed tomography were retrospectively reviewed. Those with serum C-reactive protein and white blood cell count measured on admission or within 24h of the computed tomography were selected. Computed tomography examinations were retrospectively reviewed, and final diagnoses were designated either positive or negative for pathology relating to presentation with acute abdomen. White blood cell counts, C-reactive protein levels, and pain locations were analyzed to determine whether they increased or decreased the likelihood of producing a diagnostic computed tomography. The likelihood ratio for computed tomography positivity with a C-reactive protein level above 5mg/L was 1.71, while this increased to 7.71 in patients with combined elevated C-reactive protein level and white blood cell count and right lower quadrant pain. Combined elevated C-reactive protein level and white blood cell count in patients with right lower quadrant pain may represent a potential factor that could guide the decision to perform computed tomography in non-traumatic acute abdomen.

The role of multi-detector CT (MDCT) in patients presented with non-traumatic acute abdominal conditions

Background: Acute abdominal pain classically refers to pain within the abdomen that has been present for less than 7 days from the time of presentation. The use of CT scan in the evaluation of acute abdominal pain has increased to a large extent due to high accuracy of CT in the diagnosis of specific diseases like appendicitis and diverticulitis, especially with the use of multidetector CT scanners. It has been shown that the use of intravenous contrast media increases the diagnostic accuracy of CT scan examination, with a positive predictive value of 95% in the cases of acute appendicitis. The accuracy of CT scan imaging in patients with acute abdominal pain was not affected by the lack of entral contrast material.Objectives: To evaluate the real usefulness of multi-detector CT( MDCT) in non-traumatic acute abdomen, to determine the cause of acute abdomen in those with uncertain pathological diagnosis.Patients and methods: This prospective study had been conducted at Al-Sader medical city from the first of January to the first of September 2015. Our study includes all patients presented to the emergency department with non-traumatic acute abdominal conditions with uncertain underlying cause inspite of detailed history and physical examination with negative or non-conclusive U/S, plain abdominal XR finding and the surgeon failed to identify the exact underlying pathology. This study included (80) patients, (44 male and 36 female) . Non-enhanced CT scan was done first for all patients which was sufficient to reach the diagnosis in (22) patients, contrast material were not used because blood urea was elevated in (6) patients . In (8) patients, CT angiography protocol was performed for patients with suspected mesenteric vessels pathology. In the remaining (44) patients, intravenous contrast was given manually via a wide bore cannula ( gauge 18) and post contrast scan done in the portal phase (delay time 45-50 second).Results: In this study, which was performed on (80) patients with undiagnosed nontraumatic acute abdominal conditions. We found that acute pancreatitis (20 patients)(25%) was the most common cause of undiagnosed acute abdominal pain, followed by intestinal obstruction (12 patients)(15%).While acute cholecystitis (8 patients)(10%) , portal or mesenteric vein thrombosis (8 patients ) (10%) , perforated viscus ,(6 patients)(7.5%), mesenteric arterial thrombosis (4 patients) (5%) ,left gastric artery aneurysm (2patient))(2.5%) , acute appendicitis(2 patient ) (2.5%)diverticulitis (2patient) (2.5%) and ectopic pregnancy (2patient) (2.5%). In (14 patients) (17.5%), no specific pathology could be detected.Conclusion: The role of multi-detector CT (MDCT) has an important role in the management undiagnosed acute abdominal conditions in the emergency department. Acute pancreatitis is one of the main cause of undiagnosed acute abdominal conditions.

Statistical learning approaches in diagnosing patients with nontraumatic acute abdomen

A quick evaluation is required for patients with acute abdominal pain. It is crucial to differentiate between surgical and nonsurgical pathology. Practical and accurate tests are essential in this differentiation. Lately, D-dimer level has been found to be an important adjuvant in this diagnosis and obviously outperforms leukocyte count, which is widely used for diagnosis of certain cases. Here, we handle this problem from a statistical perspective and combine the information from leukocyte count with D-dimer level to increase the diagnostic accuracy of nontraumatic acute abdomen. For this purpose, various statistical learning algorithms are considered and model performances are assessed using several measures. Our results revealed that the naive Bayes algorithm, robust quadratic discriminant analysis, bagged and boosted support vector machines, and single and bagged k-nearest neighbors provide an increase in diagnostic accuracies of up to 8.93% and 17.86% compared with D-dimer level and leukocyte count, respectively. Highest accuracy was obtained as 78.57% with the naive Bayes algorithm. Analysis has been done via the R programming language based on the codes developed by the authors. A user-friendly web-tool is also developed to assist physicians in their decisions to differentially diagnose patients with acute abdomen. It is available at http://www.biosoft.hacettepe.edu.tr/DDNAA/.

Multimodality approach for imaging of non-traumatic acute abdominal emergencies.

"Acute abdomen" includes spectrum of medical and surgical conditions ranging from a less severe to life-threatening conditions in a patient presenting with severe abdominal pain that develops over a period of hours. Accurate and rapid diagnosis of these conditions helps in reducing related complications. Clinical assessment is often difficult due to availability of over-the-counter analgesics, leading to less specific physical findings. The key clinical decision is to determine whether surgical intervention is required. Laboratory and conventional radiographic findings are often non-specific. Thus, cross-sectional imaging plays a pivotal role for helping direct management of acute abdomen. Computed tomography is the primary imaging modality used for these cases due to fast image acquisition, although US is more specific for conditions such as acute cholecystitis. Magnetic resonance imaging or ultrasound is very helpful in patients who are particularly sensitive to radiation exposure, such as pregnant women and pediatric patients. In addition, MRI is an excellent problem-solving modality in certain conditions such as assessment for choledocholithiasis in patients with right upper quadrant pain. In this review, we discuss a multimodality approach for the usual causes of non-traumatic acute abdomen including acute appendicitis, diverticulitis, cholecystitis, and small bowel obstruction. A brief review of other relatively less frequent but important causes of acute abdomen, such as perforated viscus and bowel ischemia, is also included.

Practice Guidelines for Primary Care of Acute Abdomen 2015.

Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine, in collaboration with four other medical societies, launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines (all clinical questions and recommendations were shown in supplementary information). A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on nine subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen.

Ostomy in Nontraumatic Conditions: Our Experience and Review of the Literature.

A number of nontraumatic acute abdomen can result in peritonitis leading to sepsis. In emergent conditions, various procedures like segmentary colectomy and/or subtotal colectomy with anastomosis, Hartmann's procedure, transverse colectomy, and/or expandable metallic stent (SEMS) placement can be performed, considering the status of the patient and the facilitaties of the institution. In our study, we examined the cases diagnosed as acute abdomen without the history of trauma, which had lead to a procedure requiring colostomy. We retrospectively analysed 105 cases of nontraumatic acute abdomen, resulted in a procedure requiring colostomy. American Society of Anesthesiologists (ASA) scoring and Mannheim Peritonitis Index (MPI) were used in the evaluation of the risk of mortality and morbidity. There were colonic perforations of rectosigmoid tumor in 66 cases (62.8%), sigmoid volvulus in 10 cases (9.5%), colonic anastomotic leakage in 9 cases (8.5%), intestinal adhesions in 8 cases (7.6%), mesenteric ischemia in 5 cases (4.7%), gynecological diseases in 3 cases (2.85%), strangulated hernias in 3 (2.85%), and Ogilvie syndrome in 1 case (0.95%). Rate of morbidity was found to be 25.7%, while mortality occurred in 2.8% of the cases. Cases with mortality and morbidity had ASA scores above two and MPI scores above 23. Anastomotic leakage was the only reason of mortality. In nontraumatic occasions, the management and prognosis of cases with peritonitis, general status of the patients play major roles. The prognosis rates of morbidity and mortality can be highly predicted when ASA and MPI scores are evaluated together.

NON TRAUMATIC GASTROINTESTINAL PERFORATION AS A CAUSE OF ACUTE ABDOMEN

Background
 Any part of the GI tract may become perforated, releasing gastric or intestinal contents into the peritoneal space. Causes vary. Symptoms develop suddenly, with severe pain and may be followed by signs of shock. Diagnosis is usually made by the presence of free air in the abdomen on imaging studies. Treatment is with fluid resuscitation, antibiotics, and surgery. Mortality varies with the underlying disorder and the patient’s general health.
 Objectives
 To study the clinical pattern of various gastrointestinal perforations in Surgical Emergency Department in Sulaimany.
 Patients and Methods
 This prospective study was done in Sulaimany Teaching Hospital, including all emergency, non-traumatic acute abdomen those were caused by gastrointestinal (GI) perforation from the 1st of February 2011 to the 1st of September 2012. A total of 100 patients were collected. Patient’s data were analyzed by history, examination and various laboratory investigations and radiological studies.
 Results
 The commonest cause of perforation was peptic ulcer (70%), nineteen cases (19%) were infection, and the remaining (11%) were from other causes. Seventy-two patients (72%) were male and (28%) were female, fifty cases were of age between 15-45 years. Most of the patients presented with pain in the abdomen (93%), eighty febrile, and (7%) had shock. Ninety-eight (98%) cases were surgically treated, of which 60 were recovered uneventfully, thirty-one cases developed complications and 8 died post-operatively.
 Conclusion
 To manage a case of perforated hollow viscus of any sort, a skilled surgical team which can handle these situations confidently is of prime importance.

Spectrum of diseases and diagnostic values of ultrasound in adult patients with nontraumatic acute abdomen in a nigerian tertiary health facility.

Aim and Objective:The purpose of this study was to determine the spectrum of disease on abdominal ultrasound (US) and the diagnostic efficacy of US in adult patients with nontraumatic acute abdomen at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife.Materials and Methods:The study population included consecutive 150 adult patients aged 15 years and above presenting with nontraumatic acute abdomen via the adult emergency unit or as inpatients referred to the Radiology Department of OAUTHC, Ile-Ife for abdominal US. MINDRAY D.C-6 real-time US scanner with 3.5, 5.0, and 7.5 MHz probes and Doppler facilities were used to assess the intra-abdominal organs and the findings were compared with the clinical and surgical findings in those cases that were operated.Results:The common spectrum of diseases encountered on US in this study included appendicitis (66 [44%]), ectopic pregnancy (34 [22%]), intestinal obstruction (13 [8.7%]) while the least finding was renal abscess 1 (0.7%). The correlation of US findings with surgical findings in this study showed sensitivity, specificity, and kappa agreement for appendicitis of 83.3%, 100.0%, and 0.808; ectopic pregnancy of 100.0%, 97.8%, and 0.958; acute cholecystitis of 100.0%, 100.0%, and 1.0. However, perforated viscus showed the least sensitivity (60.0%), specificity (99.2%), and kappa agreement 0.654. All the disease entities showed good kappa agreement beyond chance, and they were all statistically significant (P < 0.001).Conclusions:This study has shown a relatively high sensitivity, specificity and diagnostic accuracy of US in cases of nontraumatic acute abdomen in a careful hand. We, therefore, recommended that these advantages of US should be capitalized upon in settings where other advanced diagnostic modalities are not available.

Non-traumatic Acute Abdomen Evaluation

The term “acute abdomen” defines a clinical syndrome characterized by the sudden onset of severe abdominal pain requiring emergency medical or surgical treatment. A prompt and accurate diagnosis is essential to minimize morbidity and mortality. The differential diagnosis includes an enormous spectrum of disorders ranging from benign self-limiting diseases to conditions that require emergency surgery. The clinical diagnosis of acute abdomen can be challenging because physical examination clinical presentation and laboratory examination are often non specific and non diagnostic. It is often difficult based on history and physical examination alone to separate these patients from those who require immediate surgery. The increased availability and use of computed tomography (CT) and Ultrasonography (US) have dramatically changed the clinical examination and treatment of patients who present with acute abdominal pain. These noninvasive imaging techniques have effectively replaced exploratory as the primarymeans of examiningpatientswho present with what was formerly known asa surgical abdomen.

Comparative Study between Plain Radiography and Ultrasound Abdomen in Non Traumatic Surgical Acute Abdominal Conditions

Introduction: Acute abdomen might indicate a progressive intra-abdominal condition that is threatening to life or capable of causing severe morbidity. A good history, thorough clinical examination, laboratory investigations and imaging studies is necessary in order to arrive at a correct diagnosis. The aim of our study was to compare the diagnostic yield of traditional three-view abdominal x-ray series (upright chest x-ray, supine and upright abdominal x-rays) with that of ultrasound in patients presenting with non traumatic acute abdominal surgical pain. Methods: This prospective study was conducted between February and July 2010 on 65 consecutive patients. Critically ill patients, pregnant ladies, patient with trauma abdomen, acute abdomen due to gynaecological pathologies were excluded from our study. Detail abdominal ultrasound was done. After ultrasound traditional three-views acute abdominal x-ray series (AAS) were taken. Final diagnosis was made on the basis of operative findings/therapeutic response/ histopathological/ laboratory findings. Finally, accuracy of clinical diagnosis, plain film and ultrasound in evaluation of acute abdomen was determined. Results: Ultrasound yielded an overall sensitivity and specificity of 78.7% and 84.6.6% respectively. The AAS interpretations yielded an overall sensitivity and specificity of 23.4% and 38.40% respectively. Conclusion: Plain x ray is less sensitive in the evaluation of nontraumatic acute abdomen so it should be used together with ultrasound abdomen in order to arrive at a correct diagnosis. Nepalese Journal of Radiology; Vol. 2; Issue 2; July-Dec. 2012; 20-27 DOI: http://dx.doi.org/10.3126/njr.v2i2.7681

Etiology of non-traumatic acute abdomen in pediatric emergency departments

Acute abdominal pain is a common complaint in pediatric emergency departments. A complete evaluation is the key factor approaching the disease and should include the patient's age, any trauma history, the onset and chronicity of the pain, the related symptoms and a detailed physical examination. The aim of this review article is to provide some information for physicians in pediatric emergency departments, with the age factors and several causes of non-traumatic acute abdominal pain. The leading causes of acute abdominal pain are divided into four age groups: infants younger than 2 years old, children 2 to 5, children 5 to 12, and children older than 12 years old. We review the information about acute appendicitis, intussusception, Henoch-Schönlein purpura, infection, Meckel's diverticulum and mesenteric adenitis. In conclusion, the etiologies of acute abdomen in children admitted to the emergency department vary depending on age. A complete history and detailed physical examination, as well as abdominal imaging examinations, could provide useful information for physicians in the emergency department to narrow the differential diagnosis of abdominal emergencies and give a timely treatment.

Is serum C-reactive protein a reliable predictor of abdomino-pelvic CT findings in the clinical setting of the non-traumatic acute abdomen?

The aim of this study was to determine if serum C-reactive protein (CRP), an acute phase reactant which exhibits a rapid rise in serum in inflammatory conditions, is a reliable predictor of abdomino-pelvic CT findings in the clinical setting of the non-traumatic acute abdomen. All patients presenting with symptoms of acute abdominal pain to a level-1 emergency department over a 12-month period were included. Patients with serum CRP measured on admission and within 24h of the abdomino-pelvic CT scan were subselected and those with a history of recent surgery, malignancy, and inflammatory bowel disease were excluded (n = 241). CT findings were graded in consensus by two radiologists and visceral adipose volume and severity of adipose stranding were also assessed. Statistical analysis was performed using SPSS v17. Positive imaging findings were evident on 176 CTs (73%). There were equal numbers of positive and negative CT scans in patients with low serum level of CRP (0-5mg/L). As CRP level increased the proportion of positive CTs increased (p < 0.001, Chi-square test for trend). The likelihood ratio for positive CT findings in patients with a CRP level greater than 130mg/L was 3.45 with reported specificity and sensitivity of 90.9 and 31.4%, respectively. A low CRP level (0-5mg/L) does not out rule positive findings on CT in the clinical setting of the acute abdomen. Increasing levels of CRP predict, with increasing likelihood, positive findings on CT.

Is Laparoscopy Safe and Effective in Nontraumatic Acute Abdomen?

Progress in laparoscopic experience has increased the number of laparoscopic procedures performed, even in emergency cases. Herewith, results in a prospective series of 300 patients laparoscopically treated for nontraumatic abdominal emergencies are presented with the intent to prove the safety and feasibility of laparoscopic approach in the treatment of acute abdomen. From a prospective multicenter study performed between June 2008 and December 2009, the authors collected data on 300 patients with a provisional diagnosis of acute abdomen, laparoscopically treated or who underwent explorative laparoscopy. A correct diagnosis was made by means of laparoscopy in all 300 (100%) patients, and therapeutic laparoscopy was successfully performed in 270 (90%) patients. With laparoscopy, it was possible to modify the preoperative diagnosis and the treatment in 17 cases (5.6%). Upon statistical analysis, the conversion rate was correlated to the age of the patients (P<.0001) and to the operative time (P<.0001). The overall postoperative morbidity rate was 8%. Statistical analysis revealed that morbidity is correlated to the age of patients (P<.0001) and to the operative time (P<.0001). The mean hospital stay was 5.4 days. Laparoscopy has been shown to play a crucial role in the management of almost every abdominal emergency, offering, compared with the open approach, an initial diagnostic or explorative tool and a valid alternative in the treatment of the cause of acute abdomen with low morbidity and mortality rates.

Spectrum of CT Findings in Patients With Atrial Fibrillation and Nontraumatic Acute Abdomen

The purpose of our study was to review the wide spectrum of pertinent CT findings in patients with acute nontraumatic abdominal pain in the setting of atrial fibrillation. Underlying embolic or hemorrhagic complications are common in patients with acute nontraumatic abdominal pain in the setting of atrial fibrillation and can be accurately seen on CT.

SPECTRUM OF DISEASES IN PATIENTS WITH NON-TRAUMATIC ACUTE ABDOMEN

OBJECTIVE: To identify the spectrum of diseases leading to acute abdomen in local population, presenting in a surgical unit. DESIGN: Retrospective study. SETTING: Department of Surgery Unit-II Chandka Medical College Teaching Hospital Larkana. DURATION: A period of three years, from July 2004 to June 2007. PATIENTS AND METHODS: All patients presenting with non-traumatic acute abdominal pain were included in the study. Patients presenting with gynecological and urological causes were excluded. Their presentation, diagnosis and management were recorded from their case files and OT registers. RESULTS: During the period under review, a total of 586 patients presented with non-traumatic acute abdomen; of which there were 412 (70.30%) males and 174 (29.69%) females, with a male to female ratio of 2.3:1. The highest incidence of acute abdomen 163 (27.81%) was found in patients of 21-30 years age group, followed by under 20 age group 150 (25.59%) and 30-40 years age group 101 (17.23%). The most common cause of acute abdomen was acute appendicitis accounting for 205 (35%) admissions. These patients were mostly young males in teens and twenties. Intestinal obstruction was second leading cause accounting for 167 (28.5%) cases and this affected more commonly the middle aged persons. Five hundred and twelve (87.37%) patients were treated successfully and discharged home while 3% left against medical advice. Mortality was 9.55% and it was highest in patients presenting with perforation peritonitis. CONCLUSION: The most common cause of acute abdomen in this study was acute appendicitis affecting young population. This was followed by intestinal obstruction and gut perforation. Acute cholecystitis commonly affects the middle aged, post-menopausal women. Pancreatitis is a rare cause of acute abdomen in this area.

Contribution du scanner à la prise en charge des tableaux abdominaux aigus non traumatiques : étude de 90 patients

Objectives. To determine the contribution of computerized tomography (CT) to the management of nontraumatic acute abdomen, to evaluate interobserver agreement and the contribution of CT to cost control, to look for the predictive factors of CT. Patients and method. Ninety prospectively included patients, admitted for nontraumatic acute abdomen and examined by a surgeon, received CT examination. Diagnosis and treatment 1) envisioned before and 2) defined after CT, and 3) finally retained were compared, and the interobserver agreement was calculated after the second reading. The predictive value of the clinical and biological criteria as well as the radiological criteria characterizing these patients was sought. Results. CT was contributive in 68.9% of cases, with a reliable diagnosis and treatment strategy, defined after CT examination, for 92.2% and 90%, respectively. Interobserver agreement was 93.3%. CT contributed to reducing costs in 15.5% of patients, for an additional cost estimated at 104-139 euros. The positive predictive factors of the CT contribution were age over 70 years, localized symptoms, fever, and high CRP. Conclusion. In agreement with the literature, in our study CT appears to be a choice examination to guide patient care in nontraumatic acute abdomen.