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Acute Abdomen; Pre and Post-Laparotomy Diagnosis

Background: Abdominal pain is a common presentation that requires almost immediate management. It is sometimes crucial to diagnose at the earliest and make a decision as to operate. Therefore it is necessary for the physician to be familiar both with the presentations of common causes of abdominal pain and the validity of diagnostic tests. Diagnosis of acute abdomen before laparotomy is essential in reducing the morbidity and mortality while preventing from unnecessary operations especially where the diagnostic facilities are limited and clinical awareness plays an important role in the diagnosis and management.

Objectives: This study attempted to compare pre and post-operative diagnosis in acute abdomen.

Materials & Methods: This was an observational study, conducted from February to December 2005. The study included 139 consecutive patients referred to Sina hospital (Tehran, Iran) presented with symptoms of acute abdomen, operated to see the negative laparotomy rate, the diagnostic accuracy and predictive values of different investigations in acute abdomen. Statistical analysis was performed using SPSS software version 11.5. P value of < 0.05 was considered as a level of significance.

Results: All 139 patients with diagnosis of acute abdomen underwent emergency laparotomy. Acute abdomen was most common in the age group 20-29 years with male predominance. Acute appendicitis (57.6%) was the most common cause of surgical condition, and then the most common causes of acute abdomen were peritonitis (14.4%) and bowel obstruction (7.9%) in male and ovarian cyst torsion (24.5%) in female patients. The negative laparotomy rate was 12.2% (P value < 0.05). In 77.7% of patients, the pre and post laparotomy diagnoses were the same. The diagnostic accuracy rates in male and female patients were 92.2% and 79.6%, respectively. In our study granulocytosis had the highest sensitivity (79.3%) and X-ray had the highest specificity (88.8%).The highest positive predictive value was related to ultrasonography (97.6%), while urinalysis showed the highest negative predictive value (91%). Conclusion: The decision to operate is based on the results of a good history and thorough physical examination(s) with the guidance of investigative tools. Diagnostic modalities could guide the physician in confirming the diagnosis. An accurate diagnosis of acute abdomen can avoid from unnecessary operations so reduces the rate of negative laparotomies.

Author(s): Marjan Laal, Armita Mardanloo

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