Routine versus selective computed tomography in non-traumatic acute abdominal pain: meta-analysis of randomised trials

2020 ◽  
Vol 405 (3) ◽  
pp. 283-291
Author(s):  
Shahab Hajibandeh ◽  
Mohamed Loutfi ◽  
Shahin Hajibandeh ◽  
Adel Abulkhir ◽  
Sheik Rehman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Meta Analysis ◽  
Randomised Trials

Approach to the Patient with Abdominal Pain

2020 ◽  
Author(s):  
Dana Sajed
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Chronic Conditions ◽  
Acute Abdominal Pain ◽  
Point Of Care ◽  
Abdominal Ultrasonography ◽  
Pediatric Populations ◽  
Ed Visits ◽  
Point Of Care Ultrasonography

Abdominal pain is the most common presenting complaint in the emergency department (ED), accounting for nearly 8% of ED visits. Although many chronic conditions may cause pain in the abdomen, acute abdominal pain, defined as undiagnosed pain present for less than 1 week, is of greatest concern to the emergency practitioner. For many reasons, acute abdominal pain is often diagnostically challenging. Abdominal pain may be due to numerous causes, including gastrointestinal, genitourinary, cardiovascular, pulmonary, and other sources. Symptoms may fluctuate or change in nature, and the quality of pain can be difficult for the patient to describe. Physical examination findings, although important, are variable and can even be misleading. Despite being such a common presenting complaint, misdiagnosis is not uncommon and results in a high percentage of medicolegal actions in both and adult and pediatric populations. This review contains 5 figures, 8 tables, and 92 references Key words: abdominal computed tomography, abdominal pain, abdominal ultrasonography, pain management, point-of-care ultrasonography

scholarly journals Computed Tomography Imaging in Lemmel Syndrome: A Report of Two Cases

2019 ◽  
Vol 9 ◽  
pp. 23
Author(s):  
Giulia Frauenfelder ◽  
Annamaria Maraziti ◽  
Vincenzo Ciccone ◽  
Giuliano Maraziti ◽  
Oliviero Caleo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Acute Abdominal Pain ◽  
Imaging Modality ◽  
Biliary Duct ◽  
History Of ◽  
The Common ◽  
Solid Lesions

Lemmel syndrome is a rare and misdiagnosed cause of acute abdominal pain due to a juxtapapillary duodenal diverticulum causing mechanical obstruction of the common bile duct. Frequently, patients suffering from Lemmel syndrome have a history of recurrent access to the emergency room for acute abdominal pain referable to a biliopancreatic obstruction, in the absence of lithiasis nuclei or solid lesions at radiological examinations. Ultrasonography (US) may be helpful in evaluation of upstream dilatation of extra-/intra-hepatic biliary duct, but computed tomography (CT) is the reference imaging modality for the diagnosis of periampullary duodenal diverticula compressing the intrapancreatic portion of the common bile duct. Recognition of this entity is crucial for targeted, timely therapy avoiding mismanagement and therapeutic delay. The aim of this paper is to report CT imaging findings and our experience in two patients affected by Lemmel syndrome.

Computed tomography in acute abdominal pain: an overused investigation?

2013 ◽  
Vol 84 (3) ◽  
pp. 155-159 ◽  
Author(s):  
Brenton J. Systermans ◽  
Peter G. Devitt
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Acute Abdominal Pain

scholarly journals Conservative Management of Segmental Infarction of the Greater Omentum: A Case Report and Review of Literature

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Ramawad Soobrah ◽  
Mohammad Badran ◽  
Simon G. Smith
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Case Report ◽  
Ct Scan ◽  
Conservative Management ◽  
Acute Abdominal Pain ◽  
Correct Diagnosis ◽  
Greater Omentum ◽  
Review Of Literature ◽  
Segmental Infarction

Segmental omental infarction (SOI) is a rare cause of acute abdominal pain. Depending on the site of infarction, it mimics conditions like appendicitis, cholecystitis, and diverticulitis. Before the widespread use of Computed Tomography (CT), the diagnosis was usually made intraoperatively. SOI produces characteristic radiological appearances on CT scan; hence, correct diagnosis using this form of imaging may prevent unnecessary surgery. We present the case of a young woman who was treated conservatively after accurate radiological diagnosis.

scholarly journals Apendagite epiploica do apêndice cecal - um relato de caso raro / Acute epiploic appendagitis of the appendix - a rare case report

2019 ◽  
Vol 65 (1) ◽  
pp. 1
Author(s):  
Kamila Motta Stradiotti ◽  
Felipe Pires de Albuquerque ◽  
Maria Laura Silveira de Castro ◽  
Laiane Milani de Arruda
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Case Report ◽  
Acute Abdomen ◽  
Laboratory Tests ◽  
Acute Abdominal Pain ◽  
Correct Diagnosis ◽  
Diagnostic Methods ◽  
Diagnostic Challenge ◽  
Epiploic Appendagitis

Introdução: Apendagite epiplóica (AE) é uma causa incomum de dor abdominal causada por alterações inflamatórias e isquêmicas relacionadas à torção ou trombose venosa dos apêndices epiplóicos. Estas estruturas consistem em projeções de tecido adiposo que emergem da superfície serosa do cólon e apêndice cecal, sendo maiores e mais numerosas no cólon descendente e sigmóide. A apendagite epiplóica do apêndice cecal (AEA) é uma forma ainda mais rara de apresentação, tendo poucos casos relatados em literatura. Os sinais e sintomas da AE comumente mimetizam outras causas de abdome agudo, que varia dependendo da sua localização, devendo ser considerada no diagnóstico diferencial de dor abdominal localizada. O diagnóstico correto é fundamental para evitar gastos e procedimentos desnecessários, pois se trata de uma condição benigna e autolimitada, com tratamento conservador sendo suficiente na grande maioria dos casos. Atualmente a tomografia computadorizada é o método de escolha na avaliação de pacientes com abdome agudo. Objetivo: Relatar um caso raro de dor abdominal aguda causada por apendagite epiplóica do apêndice cecal e a importância do seu diagnóstico correto. Relato do caso: Paciente com quadro de dor abdominal aguda no quadrante inferior direito, afebril e sem outras queixas gastrointestinais associadas. Ao exame físico referiu dor à palpação profunda no quadrante inferior direito. Exames laboratoriais sem alterações. Foram solicitados exames de imagem complementares, evidenciando apêndice cecal nos limites superiores da normalidade, inflamação periapendicular e uma imagem com densidade de gordura adjacente ao apêndice. Os diagnósticos diferenciais foram de apendicite inicial e apendagite epiplóica. Foi realizado tratamento operatório e exame anatomopatológico, que confirmou o diagnóstico de apendagite epiplóica do apêndice cecal. As informações foram obtidas por meio de revisão do prontuário, entrevista com o paciente, registro dos métodos diagnósticos, incluindo exames laboratoriais, exames de imagem como tomografia computadorizada e anatomopatológico, aos quais o paciente foi submetido e uma breve revisão da literatura. Conclusão: Relatamos um caso raro de apendagite epiplóica do apêndice cecal, demonstrando um desafio diagnóstico e a importância dos métodos de imagem. Palavras Chave: Dor abdominal, Abdome agudo, Apêndice cecal, Diagnóstico por imagemABSTRACT: Introduction: Epiploic appendagitis (LA) is an uncommon cause of abdominal pain caused by inflammatory and ischemic changes related to venous torsion or thrombosis of the epiploic appendages. These structures consist of projections of adipose tissue that emerge from the serous surface of the colon and cecal appendix, being larger and more numerous in the descending and sigmoid colon. Epiploic appendagitis of the appendix (EAA) is an even rarer form of presentation, with few cases reported in the literature. The signs and symptoms of EAA commonly mimic other causes of acute abdomen, which varies depending on their location, and should be considered in the differential diagnosis of localized abdominal pain. Correct diagnosis is essential to avoid unnecessary expenses and procedures, as it is a benign and self-limited condition, with conservative treatment being sufficient in the vast majority of cases. Currently, computed tomography is the method of choice in the evaluation of patients with acute abdomen. Objectives: To describe a rare cause of abdominal pain due acute epiploic appendagitis of the appendix and reinforce the importance of the CT to diagnosis this condition and rule out other causes of acute abdominal pain. Case report: Patient with acute abdominal pain in the lower right quadrant, afebrile and without other associated gastrointestinal complaints. On physical examination, she reported pain on deep palpation in the lower right quadrant. Laboratory tests without changes. Complementary imaging exams were requested, showing the appendix at the upper limits of normal, periapendicular inflammation and an image with fat density adjacent to the appendix. The differential diagnoses were of initial appendicitis and epiplatic appendagitis. Operative treatment and anatomopathological examination were performed, which confirmed the diagnosis of appendagitis of the appendix. Information was obtained by reviewing medical records, interviewing the patient, recording diagnostic methods, including laboratory tests, imaging tests such as computed tomography, anatomopathology, and a brief review of the literature. Conclusion: We report a case of acute epiploic appendagitis of the appendix, demonstrating a diagnostic challenge and the importance of imaging methods.Keywords: Abdominal pain; Abdomen, acute; Appendix, Diagnostic imaging

scholarly journals Conservative Treatment of Spontaneous Rectus Sheath Hematomas: Single Center Experience and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Banu Karapolat ◽  
Halil Afsin Tasdelen ◽  
Hatice Ayca Ata Korkmaz
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Correct Diagnosis ◽  
Rectus Sheath ◽  
Length Of Hospital Stay ◽  
Initial Symptom ◽  
Abdominal Ultrasonography ◽  
Palpable Mass ◽  
Lower Quadrant

Introduction. Spontaneous rectus sheath hematoma (SRSH) is characterized by bleeding within the rectus abdominis muscle sheath, one of the rare causes of acute abdominal pain. Early diagnosis is imperative in SRSH to prevent complications and the treatment is usually conservative. We intended to present in this study our experience with SRSH patients with respect to diagnostic evaluation and management of their disease. Materials and Methods. In this retrospective study, 14 patients who had received treatment for SRSH in our clinic between January 2012 and December 2017 were assessed in terms of demographic and clinical characteristics, comorbidities, laboratory parameters, diagnostic approach methods, treatment practices, length of hospital stay, and patient outcomes. Results. The patients consisted of 10 (71.4%) females and 4 males (28.6%). The age of the patients ranged between 47 and 93 with a mean age of 66.5 ± 12.1. Anticoagulant treatments were being administered to 5 (35.7%) patients, antiplatelet treatments to 4 (28.5%) patients, and both anticoagulant and antiplatelet treatments to 4 (28.5%) patients. The most common triggering factor was severe cough and the most common initial symptom acute abdominal pain (71.4%). In physical examinations, the entire patients had generalized abdominal tenderness, 10 (71.4%) voluntary guarding and 7 (50%) a right lower quadrant mass. The diagnosis was confirmed by abdominal ultrasonography and computed tomography. Based on the computed tomography findings, the disease was classified as Type 2 found in 9 (64.3%) patients, Type 1 in 3 (21.4%) patients, and Type 3 in 2 (14.2%) patients. All the patients were treated conservatively. They were hospitalized for 1 to 23 days. There was no mortality. All the patients were followed up between 3 months and 2 years and no recurrence was recorded. Conclusion. Considering the presence of SRSH particularly in older female patients who use anticoagulant drugs and have newly developed an abdominal pain and a palpable mass after coughing spells is the key to make an early and correct diagnosis and to prevent possible morbidity and mortality with an appropriate treatment method.

The use of abdominal computed tomography in older ED patients with acute abdominal pain

2005 ◽  
Vol 23 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Fredric M. Hustey ◽  
Stephen W. Meldon ◽  
Gerald A. Banet ◽  
Lowell W. Gerson ◽  
Michelle Blanda ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Abdominal Computed Tomography
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