Comparative study of preoperative with postoperative diagnosis in acute abdomen

Acute abdomen refers to sudden, spontaneous, non-traumatic abdominal pain of less than a week. It is one of the common causes of emergency room visits and abdominal surgery. Therefore, it is critical for healthcare professionals to be familiar with the presentations of the common causes of acute abdomen, as well as the strength and validity of the investigative tools.

In this hospital-based observational study (September 2023 to August 2024), a total of 81 patients with acute abdomen who underwent emergency surgery were enrolled. Data were collected using a proforma, and statistical analysis was performed using IBM SPSS v28 (P value < 0.05 considered significant).

Among 81 patients included in this study, acute abdomen was most common in males and the 16-25-year age group. Common symptoms of acute abdomen were abdominal pain, nausea/vomiting, anorexia, constipation/obstipation, and fever, while common signs were tenderness, rebound tenderness, guarding/rigidity, tachycardia, and abdominal distention. The most common postoperative diagnosis was acute appendicitis (33.33%), and including its sequelae, it accounted for 51.85%. The next most common pathologies were perforation peritonitis (22.2%) and bowel obstruction (21%). Ultrasonography (USG) was the most specific tool in the diagnosis of appendicular pathologies (Sn = 73.81%, Sp = 96.87%, and accuracy = 83.78%). In cases of perforation peritonitis, clinical signs of generalized peritonitis were an equally effective method, with sensitivity comparable to an X-ray. The most sensitive tool in bowel obstruction was plain abdominal X-ray (sensitivity [Sn] = 88.24%), while USG had the highest specificity (Sp) of 94.74%. The diagnostic accuracy of acute abdomen was 88.89%, and the negative laparotomy rate was nil.

This study highlights the critical nature of accurate preoperative diagnosis in acute abdomen cases and the potential for improved patient outcomes through enhanced investigative strategies. For better outcomes in patients with acute abdomen, early diagnosis based on clinical findings, supported by laboratory and radiological correlation, followed by timely decision-making regarding operative management, is of utmost importance.