Objectives: Evaluation of the diagnostic yield of preoperative abdominal CT imaging of
patients presenting by acute right lower abdominal pain and the probability for reduction of
negative appendectomy rates in these patient.
Patients & methods: The present study aimed to include patients presenting with acute right
lower abdominal pain who were admitted as acute abdominal emergency under observation.
All enrolled patients underwent clinical examination and laboratory investigations to provide
a probable clinical diagnosis. All patients underwent abdominal ultrasonography (US) and then
scanning with multi-detector row CT. All patients with clinical suspicion for need of surgical
exploration underwent laparotomy and excised specimens were examined pathologically. Patients
who became stable with negative US and/or CT were maintained under-observation till 24 hours
and were discharged.
Results: One hundred and seventeen patients underwent surgical exploration including 81
patients who had emergency surgery and 36 who had surgery on elective basis during observation
period. Pathological examination confirmed positive diagnosis of acute abdomen in 78 patients
and 39 patients were pathologically free (Negative laparotomy). Clinical diagnosis defined 79,
abdominal US defined 83 and CT defined 74 patients as having positive acute abdominal
condition. Preoperative CT showed a significantly higher test validity characters in comparison
to abdominal US and clinical examination with sensitivity rate of 94.6%, speccity rate of
90.7% and accuracy rate for diagnosis of 93.2%. Statistical analysis defined preoperative CT
as the best predictor for negative laparotomy.
Conclusion: Preoperative CT for patients with acute right lower abdominal pain reduces the
negative laparotomy rate, improves true positive surgical rate and is mandatory especially in
suspicious cases. Moreover, preoperative CT could help dWerential diagnosis of the underlying
pathology and so can modify surgical decision.
Key words: Preoperative, CT, acute right lower abdominal pain, negative laparotomy. |
