Ultrasonography in the acute abdomen

Area of Science:

• Emergency Medicine
• Diagnostic Imaging
• Surgical Diagnostics

Background:

• Acute abdominal pain is a common presentation in emergency departments.
• Diagnostic imaging plays a crucial role in evaluating acute abdominal pain.
• The utility of routine immediate ultrasonography in the undifferentiated acute abdomen requires further investigation.

Purpose of the Study:

• To evaluate the diagnostic yield and clinical impact of routine immediate ultrasonography in patients presenting with acute abdominal pain.
• To compare the diagnostic accuracy of ultrasonography with clinical assessment for appendicitis.
• To determine the appropriate role of ultrasonography in the acute abdomen management pathway.

Main Methods:

• Prospective study of 152 consecutive patients with acute abdominal pain.
• Clinical assessment followed by immediate ultrasonographic examination.
• Analysis of diagnostic alterations, missed diagnoses, and diagnostic performance metrics (sensitivity, specificity, predictive values, accuracy).

Main Results:

• Ultrasonography would have been requested immediately in 11% and routinely within 24 hours in 43% of patients.
• Ultrasonography altered the diagnosis in only one patient (cholecystitis vs. appendicitis).
• Diagnostic performance for appendicitis was high (sensitivity 96%, specificity 94%, accuracy 95%), matching clinical diagnosis.
• Missed diagnoses included one abdominal aortic aneurysm and one gallbladder empyema.

Conclusions:

• Routine immediate ultrasonography is rarely helpful for the general acute abdomen, except possibly for appendicitis.
• Urgent ultrasonographic scans on clinical suspicion may necessitate radiologist expertise.
• Training surgical trainees in specific diagnostic areas, such as right iliac fossa pain, may be beneficial.