A comparative study of pre-operative with operative diagnosis in acute abdomen (original) (raw)

Comparative Analysis of Clinical, Radiological and Operative Findings in Acute Abdomen

2015

A prospective observational study was conducted on 125 patients with acute abdomen to compare clinical, radiological and operative finding. The most common age group was 21-30 years with male preponderance. Nausea or Vomiting were most predominant symptoms in these patients. Anorexia followed by fever was the next important symptom. Guarding was the single statistically significant sign (p=.02), other common signs were tenderness, rigidity, distention, tachycardia and silent abdomen. A total of 59(47.2%) patients had raised total leucocyte count with sensitivity of 47.54%, and specificity of 66.67% respectively (p = .58); differential leukocyte count was raised in 86(68.8%) patients with sensitivity of 70.49% and positive predictive value of 97.73% the test was statistically significant (p = .0092). Appendicitis was the most common cause of laparotomy followed by perforation peritonitis, obstruction and mesenteric ischemia. Diagnostic accuracy of X-ray was 72.86% while that of US wa...

Clinical study, diagnostic aids and management of acute abdomen

International Journal of Current Research in Biology and Medicine

Background: Evaluation of the emergency department(ED) patient with acute abdomen is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. The term acute abdomen is constantly applied to such cases that signify the urgent need for prompt diagnosis and active treatment. Objective: This study is designed to examine the present state of diagnosis and management of acute abdomen and to develop evidence based guidelines for the diagnostic pathway and management of acute abdomen. Result: Our study showed that acute cholecystitis was the most common cause (29%) in patients presenting with acute abdomen followed by perforation peritonitis (25%). Pain and vomiting (49%) was the most common complaint followed by distension (44%). Ultrasound is the most sensitive and most commonly used diagnostic aid in acute abdomen. Majority of patients(73%) required surgical intervention. Conclusion: Abdominal pain is a common presenting complaint in the ED and clinicians must consider multiple diagnoses, especially in those cases that require immediate intervention in order to limit morbidity and mortality.

Co-relation between pre-operative imaging findings and per-operative findings in acute abdomen

International Surgery Journal, 2019

Background: The term acute abdomen refers to a sudden, severe abdominal pain that is less than 24 hours in duration. It is in many cases an emergent condition requiring urgent and specific diagnosis and/or surgical interventions. Abdominal pain can be just one of the symptoms. Most frequently its cause is benign and/or self-limited, but more serious causes may require urgent intervention. Many new diagnostic and management aids have been introduced into the surgical decision-making process over the past decade or so to improve clinical performance. Correct pre-operative diagnosis of acute abdomen remains challenging despite good history taking and clinical examination, and improvement in new imaging techniques including computer-aided diagnosis, ultrasound imaging, computed tomography and laparoscopy. These imaging techniques need sophisticated equipment and specialist expertise round the clock which is not feasible always. Hence, we have tried studying the accuracy of clinical corr...

Management of acute abdomen : Study of 110 cases

2016

Background: The term acute abdomen designates symptoms and signs of intraabdominal diseases usually treated best by surgical operation. Many diseases, some of which do not require surgical treatment, produce abdominal pain, so the evaluation of patients with abdominal pain must be methodical and careful. The proper management of patients with acute abdominal pain requires a timely decision about the need for surgical operation. The term “acute abdomen” should never be equated with the invariable need for operation. The abdomen has been referred to as Pandora’s magic box. Very often an accurate diagnosis cannot be made without surgery and many wonders are revealed on opening the abdomen. So it is often the last court of appeal in investigating abdominal cases. The general rule can be laid down that the majority of severe abdominal pains that ensue in patients who have been previously well, and that last as long as six hours, are caused by conditions of surgical import. Materials and ...

A comprehensive study on acute non-traumatic abdominal emergencies

International Surgery Journal, 2017

Background: Abdominal pain is one of the most common reasons for visit to the emergency room. Acute appendicitis is the commonest cause. An accurate diagnosis is essential for the correct treatment, which in many cases will prevent the death of the patient. Mainstay of diagnosis is history and physical examination. If this information is inadequate to establish a diagnosis and urgent or immediate operation is unnecessary, the periodic re-examination helps document the progression of the disease and often avoids unnecessary surgical intervention. Today the combination of improved diagnostic procedures, antibiotic and better anaesthesia and preoperative and postoperative patient care has led to a decrease in morbidity and mortality of patients with acute abdomen. The objective of this study was to determine the various causes of non-traumatic acute abdominal emergencies, their incidence, management and mortality in both sexes and all age groups >12 years age.Methods: The Study was ...

Role of Laparoscopy in Early Diagnosis and Further Management: In A Cases of Acute Abdominal Pain

IOSR Journals , 2019

Background: Diagnostic laparoscopy is minimally invasive surgery for the diagnosis of intra-abdominal diseases. Patient with acute abdominal pain are challenging for both diagnostic and therapeutic point of view. Diagnostic laparoscopy is now almost unanimously accepted as the preferred approach for treatment of many diseases, Diagnostic laparoscopy not only facilitate to diagnosis of intra-abdominal diseases but also therapeutic interventions possible in the hand of properly trained laparoscopic surgeon, it is possible due to improvement in instrumentation and greater experience with therapeutic procedures. Material and Methods: This is Prospective observational study, From May 2003 to April 2006, 3 year duration included 50 patients presenting with acute abdominal pain, admitted in surgical wards at Tertiary care Hospital, underwent laparoscopic examination and treatment. Inclusion criteria: 1 All cases of acute abdominal pain. 2. Patients willing to participate in study. Exclusion criteria: 1. Patients in shock. 2. Ongoing Radiation therapy. 3. Pregnant women, women who had recently given birth. 4. Those with severe Coagulation defects. 5. Patients with intra-abdominal Catastrophe who will directly require exploratory laparotomy. RESULT: In this study out of 50 cases, 29 Cases (58%) were female while 21 cases (42%) were Male hence Male: Female ratio was 1: 1.3. Among 50 cases, age ranges from 10-60 years, maximum reported age group was 21-30 year, seen in 24 cases (48%), and minimum reported age group was 51-60 year, 1 case (2%). Pain was the commonest chief complain observed in 48 cases (96%). Vomiting in 35 cases (70%). fever27 cases (54%). Distension in 18 cases (36%). Constipation 11 cases (22%), heartburn, Loose motion in few cases. The duration of onset of pain till the hospital admission is varies, admission within 48 hours seen in 25 cases (50%), followed by 2-4 days seen in 14 cases (28%). Out of 50 cases diagnosis were confirmed by Radiological investigation in 20 cases (40%), 17 cases was diagnosed clinically. During diagnostic Laparoscopy, diagnosis confirmed in maximum cases hence therapeutic intervention carried out simultaneously commonest procedure performed it was Appendectomy in 23 cases (46%), and cholecystectomy in 12 cases (24%). Post-operative hospital stay was significantly reduced, 26 patients (52%) were discharged within 2 days. Post-op complications also minimal, like port site infection, fever and vomiting. CONCLUSION: DiagnosticLaparoscopy and further management of Acute Abdominal pain, is safe and effective procedure with minimally invasive technique which reduced the complication and early outcome of patient from mental and physical trauma. It can be used as routine technique to avoid major exploratory Laparotomy in a critically ill patients.

Role of Laparoscopy in Management of Doubt Cases of Acute Abdomen

International Journal of Medical Arts, 2021

Background: Acute abdomen is a surgical emergency, that needs early diagnosis and treatment to avoid complications and save patient life. However, accurate diagnosis is crucial to avoid unnecessary surgery. Laparoscopy could represent an optimal solution in these circumstances. The aim of the work: To evaluate the role of laparoscopy in management of doubt cases of acute abdomen. Patients and Methods: It is a prospective study, which held at Al-Azhar University Hospital [Damietta] during the first six months of 2020 and included 30 patients who presented by acute abdominal pain. All were evaluated by full history taking, clinical examination, laboratory and radiological investigations. Then, all underwent diagnostic laparoscopy, which had been continued to therapeutic laparoscopy, or converted to laparoscopy-assisted laparotomy at the same setting. Rate of success, operative diagnosis and postoperative complications were documented. Results: The most common cause of acute abdomen was acute appendicitis [23.33%] followed by acute cholecystitis [13.33%], then perforated peptic ulcer [10.0%]. Negative exploration had been reported in 10%. Therapeutic laparoscopy was successful in [56.7%] while [43.3%] required conversion to laparotomy. Complications were observed in 14 patients [46.7%] and wound infection is the most common [30.0%]. Radiological investigations failed to elaborate diagnosis in 12 patients, and laparoscopy achieved the diagnosis in 9 [75.0%] of them. Conclusion: The laparoscopic approach in doubt acute abdomen is proved to be feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities. It reduces pain, improves recovery, shortens hospitalization and improves cosmetic results.

Laparoscopy in the acute abdomen

Best Practice & Research Clinical Gastroenterology, 2014

Laparoscopy has become a routine procedure in the management of acute abdominal disease and can be considered both an excellent therapeutic and additional diagnostic tool in selected cases. However, a high level of expertise in laparoscopic and emergency surgery is required. Hemodynamic instability, huge abdominal distension, fecal peritonitis and perforated cancer are relative contraindications for the laparoscopic approach. In recent years, abdominal emergencies have increasingly been managed successfully by laparoscopy. In acute appendicitis, acute cholecystitis and perforated peptic ulcer, randomized controlled trials have proven that the laparoscopic approach is as safe and as effective as open surgery, with fewer complications and a quicker postoperative recovery. Other indications such as blunt and penetrating trauma to the abdomen, small bowel occlusion and perforated diverticular disease are under debate, indicating that more randomized controlled trials comparing laparoscopic and open surgery are still necessary.

Study of role of laparoscopy in acute abdomen

International Journal of Biomedical Research, 2015

Study regarding role of laparoscopy in acute abdomen was conducted at Shree Chhatrapati Shivaji Maharaj Sarvopachar Rugnalaya, Solapur during the period from May 2004 to November 2006. Patients of both sex and all age groups were included in the study. A total 30 patients were studied and results were as tabulated and analysed. In this study, total laparoscopic management was possible in 23 cases (76.7%) while laparoscopy assisted surgery were done in 4 cases (13.3%). In this study, 5 cases presented as adhesive small bowel obstruction, 1 with inflamed Meckels diverticulum and 1 as case of ileoileal intussusception. All these findings were missed on radiological investigations, but werediagnosed accurately on laparoscopy. Laparoscopic treatment was done in 9 cases presented as acute abdomen due to intestinal obstruction. This incidence is equal to that of acute cholecystitis. Of these, 5 patients (55.6%) were due to post operative adhesions. We conclude that laparoscopy is valuable, safe feasible and accurate alternative for management of patients of acute abdomen. It is very useful for final diagnosis of patients of acute abdomen. Even negative laparotomies can be avoided using laparoscopy. Therapeutic laparoscopy can be accomplished in majority of patients of acute abdomen.

Laparoscopy in acute abdomen between encouragement and inhibition

International Surgery Journal, 2019

Background: Laparoscopy has been a valuable technique in the treatment of acute abdominal diseases and can be considered either to diagnose or to treat selected cases.Methods: Here, we randomly select patients with acute abdominal pain in whom the diagnosis was not clear after ultrasonography and plain X-ray, we did diagnostic laparoscopy and according to its findings, we proceeded to surgical intervention. 50 cases with acute abdomen were included in this study in order to clarify the role of laparoscopy in the diagnosis and treatment of acute abdomen.Results: From the 50 patients, the main complaint was abdominal pain and presented in (100%) of patients, 38 of patients had vomiting, fever in 29 patients and 14 patients had abdominal distension, 7 patients had alteration in bowel habits and burning micturition in 6 patients. In this study, 10 patients had past history of previous surgery. By laparoscopy we could see the pathology in 46 patients and complete the management in all of...