The Utility of CT Scan For the Diagnostic Evaluation of Acute Abdominal Pain

Publication date: Available online 20 February 2019Source: The American Journal of SurgeryAuthor(s): Timothy Bax, Matthew Macha, John MayberryAbstractAbdCT for the evaluation of AAP in the ED in the US may be excessive and is potentially (although rarely) misleading and harmful. A selective policy of ‘AbdUS first’ combined with an observation unit and/or surgeon evaluation prior to AbdCT is preferred to a ‘routine AbdCT’ policy. Repeated AbdCTs for abdominal pain are not recommended because of cumulative radiation exposure. Standardized and complete history and physical examination, such as that originally designed for computer-aided diagnosis of AAP, along with select laboratory testing and higher utilization of AbdUS lessens the necessity of AbdCT. ‘Routine AbdCT’ is particularly not necessary for the evaluation of suspected appendicitis. ‘Routine AbdCT’ lowers the negative appendectomy rate but at the expense of exposure to radiation. Right lower quadrant US and selective use of observation prior to AbdCT for suspected appendicitis, particularly in children, adolescents, and young adults, are warranted. MRI should substitute for AbdCT for the evaluation of suspected appendicitis during pregnancy.
Source: The American Journal of Surgery - Category: Surgery Source Type: research

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Abstract Abdominal pain is a common occurrence in pregnant women and may have a variety of causes, including those that are specific to pregnancy (eg, round ligament pain in the first trimester) and the wide range of causes of abdominal pain that affect men and women who are not pregnant (eg, appendicitis, acute cholecystitis). Noncontrast magnetic resonance (MR) imaging is increasingly performed to evaluate pregnant women with abdominal pain, either as the first-line test or as a second test following ultrasonography. The imaging appearance of causes of abdominal pain in pregnant women are reviewed with an emphas...
Source: Radiologic Clinics of North America - Category: Radiology Authors: Tags: Radiol Clin North Am Source Type: research
Abstract A 31-year-old multigravida woman 16 weeks pregnant by natural conception presented with right lower abdominal pain and bloody emesis. She was hypotensive and anemic with hemoperitoneum resulting from rupture of an ectopic pregnancy. At operation, she was found to have a right tubal heterotopic pregnancy with attachments to the appendix and omentum. PMID: 32063785 [PubMed]
Source: Baylor University Medical Center Proceedings - Category: Universities & Medical Training Authors: Tags: Proc (Bayl Univ Med Cent) Source Type: research
We describe a patient who presented with abdominal pain at 13 weeks of gestation and was diagnosed with placenta percreta during laparoscopy for presumed appendicitis. Intraoperatively, placenta was seen perforating the uterine fundus and 1 l of hemoperitoneum was evacuated. However, the uterus was hemostatic and the patient was stable, so the procedure was terminated. The patient was then transferred to a tertiary care center, where she ultimately underwent an uncomplicated laparoscopic gravid hysterectomy. We conclude that placenta percreta can occur in the first trimester even in patients without traditional risk fa...
Source: Case Reports in Womens Health - Category: OBGYN Source Type: research
CONCLUSIONS: The sensitivity and specificity of CT for diagnosing appendicitis in adults are high. Unenhanced standard-dose CT appears to have lower sensitivity than standard-dose CT with intravenous, rectal, or oral and intravenous contrast enhancement. Use of different types of contrast enhancement or no enhancement does not appear to affect specificity. Differences in sensitivity and specificity between low-dose and standard-dose CT appear to be negligible. The results of this review should be interpreted with caution for two reasons. First, these results are based on studies of low methodological quality. Second, the c...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Abdominal pain is a common occurrence in pregnant women and may have a variety of causes, including those that are specific to pregnancy (eg, round ligament pain in the first trimester) and the wide range of causes of abdominal pain that affect men and women who are not pregnant (eg, appendicitis, acute cholecystitis). Noncontrast magnetic resonance (MR) imaging is increasingly performed to evaluate pregnant women with abdominal pain, either as the first-line test or as a second test following ultrasonography. The imaging appearance of causes of abdominal pain in pregnant women are reviewed with an emphasis on noncontrast MR imaging.
Source: Radiologic Clinics of North America - Category: Radiology Authors: Source Type: research
We present the case of unilateral nonhemorrhagic adrenal infarct in a 29-week pregnant 21-year-old woman. The patient presented with right upper quadrant pain, nausea, and vomiting. Ultrasonography of the right upper quadrant and appendix was negative for pathology. Magnetic resonance imaging of the abdomen demonstrated a right nonhemorrhagic adrenal infarct, subsequently confirmed with limited computed tomography of the upper abdomen. This case discusses the clinical presentation and pertinent imaging findings of adrenal infarction in pregnancy.
Source: Journal of Computer Assisted Tomography - Category: Radiology Tags: Abdominal Imaging Source Type: research
CONCLUSION: ACUTE ABDOMEN sonographic approach in acute abdomen can play an important role in ruling out critical diagnosis, and can guide emergency physician or any critical care physician in patient management. PMID: 31544223 [PubMed]
Source: Pain Physician - Category: Anesthesiology Authors: Tags: Ultrasound J Source Type: research
ConclusionACUTE ABDOMEN sonographic approach in acute abdomen can play an important role in ruling out critical diagnosis, and can guide emergency physician or any critical care physician in patient management.
Source: Critical Ultrasound Journal - Category: Radiology Source Type: research
Rationale Abdominal pain in pregnancy represents a demanding diagnostic challenge in the emergency department (ED) due to the extensive list of differential diagnoses to be considered, coupled with the possibility of each disease having nonclassical, atypical signs and symptoms, resultant from the patient's pregnant state. Additionally, emergency physicians (EPs) face limitations on investigative imaging modalities because of the need to minimize fetal radiation exposure. EPs have to tackle this diagnostic challenge while performing a balancing act to maximize both maternal and fetal outcomes in a time-sensitive manner, ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
ConclusionsOur results demonstrate that urgent laparoscopic surgeries in the third trimester of pregnancy are feasible, and they can be safely performed with minimal risk for the patient and fetus. Larger prospective studies are required to validate these recommendations.
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
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