Rethinking Routine: Oral Contrast-free MDCT in Acute Abdominal Pain Assessment

In emergency settings, computed tomography (CT) accurately detects surgical pathology and reduces unnecessary hospital admissions. This study compared the diagnostic performance of multidetector computed tomography (MDCT) of the abdomen with and without oral contrast (OC) in patients with non-traumatic acute abdominal pain.

This one-year study, conducted at Maulana Azad Medical College and its affiliated hospitals in New Delhi, enrolled 50 patients aged 18 years or older, who were randomly assigned to two groups. Group I underwent MDCT with intravenous (IV) contrast alone, while group II received both oral and IV contrast. Bowel findings were qualitatively assessed, and radiological diagnoses were correlated with surgical, pathological, or clinical outcomes. The mean CT completion time was 1.69 hours for group I and 2.5 hours for group II, representing a 49-minute reduction when OC was omitted.

The final MDCT diagnosis matched the clinical diagnosis in 23 of 25 cases (92%) in group I and 24 of 25 cases (96%) in group II, with no statistically significant difference (p = 0.99). The positive predictive values were 92.0% and 96.0%, respectively. Two false positive results occurred in group I, while group II had one false positive case. No cases required repeat scanning.

Patients with acute abdominal pain can be effectively evaluated with MDCT using IV contrast alone, particularly for acute appendicitis and pancreatitis.

Eliminating routine OC use in acute abdominal pain may reduce emergency department length of stay and CT completion time without compromising diagnostic accuracy.

Kumar A, Satyam S, Prakash A, et al. Rethinking Routine: Oral Contrast-free MDCT in Acute Abdominal Pain Assessment. Euroasian J Hepato-Gastroenterol 2025;15(2):127-135.