The atraumatic acute abdomen-A comparative analysis of clinical, radiological and operative findings
Govind P Somani, MA Balakrishna
Background and objectives: "The term acute abdomen refers to signs and symptoms of abdominal pain and tenderness, a clinical presentation that often requires emergency surgical therapy". To study the incidence of non-traumatic acute abdominal emergencies. To assess the association between clinical, radiological and operative findings in a case of atraumatic acute abdomen and thus to evaluate clinical diagnostic accuracy and radiological diagnostic accuracy.Methods: Hundred patients with atraumatic acute abdomen who underwent surgical intervention at KVGMC&H were included in the study. Patient’s clinical, biochemical and radiological data was collected prospectively and was compared to final intraoperative diagnosis.Results: The highest incidence is seen in age group of 11-30yrs. Majority of them were males. Total white cell count had a sensitivity of 92.86% and specificity of 31.8% Acute appendicitis (58%) is the commonest cause of acute abdomen followed by perforation of hollow viscus (34%), Intestinal obstruction (4%), Meckel’s Diverticulitis (2%), Liver Abscess (2%). Sensitivity and Specificity of clinical diagnosis in diagnosing appendicular pathology were 96.5% and 95.2% respectively. Sensitivity and Specificity of clinical diagnosis in diagnosing hollow viscous perforation was 100% and 96.9% respectively. Sensitivity and Specificity of plain X-ray abdomen in diagnosing hollow viscous perforation was 94.1% and 96.9% respectively. Sensitivity and Specificity of Ultrasonogram in diagnosing appendicular pathology was 93.1% and 95.2% respectively. Sensitivity and Specificity of plain x-ray abdomen in diagnosing intestinal obstruction was 100% and 100% respectively. Interpretation and Conclusion: Acute appendicitis was the commonest cause of acute abdomen followed by hollow viscous perforation. Commonest in age group of 11-30yrs. Male predominance was noted. Plain X-ray abdomen was useful in cases of hollow viscus perforation and intestinal obstruction. Not all patients with acute abdomen necessitated plain X-ray of abdomen. Ultrasonogram was more accurate in case of acute appendicitis and was contributory in diagnosis of intestinal obstruction. Apart from clinical diagnosis, the laboratory tests and radiological investigations were complimentary to arrive at an accurate diagnosis of acute abdomen.