title: Should routine spiral computed tomography be performed in adult patients with acute abdominal pain of the right lower quadrant?
abstract: OBJECTIVE
  To determine whether spiral computed tomography (SCT) is helpful in the management of adult patients with acute pain of the right lower quadrant.
  
  
  METHODS
  The prospective study included 204 patients with acute pain of the right lower quadrant during two periods: 104 before and 100 after the introduction of SCT. A questionnaire was completed for each patient before and after standard clinical and laboratory assessment and SCT, indicating the suspected diagnosis and a provisional therapeutic option.
  
  
  RESULTS
  In the pre-SCT period the negative laparotomy rate was 29% vs. only 13% in the SCT period. During the SCT period 10 of the 24 nonoperated patients were discharged on the same day, and 14 were hospitalized 1.6+/-1 days, and only one was readmitted for operation on day 7. The accuracy of SCT assisted by results of clinical and laboratory findings (true positives + true negatives/total of patients) was 86% (vs. 73% for standard clinical and laboratory assessment): 93% in men (vs. 76% for standard clinical and laboratory assessment) but only 63% in women (vs. 60% for standard clinical and laboratory assessment). SCT changed the therapeutic decision guided by standard clinical and laboratory assessment in 18 cases, accurately in 16 cases (90%).
  
  
  CONCLUSIONS
  SCT is helpful in the management of adult patients with acute abdominal pain of the right lower quadrant. In our study it reduced negative laparotomy rate from 29% (guided by standard clinicobiological evaluation) to only 13%.
authors.affiliation: Department of Surgery, Lariboisière Hospital, 2, rue Ambroise Paré, 75475 Paris Cedex 10, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Regimbeau
authors.forename: Y
authors.initials: Y
authors.lastname: Panis
authors.forename: P
authors.initials: P
authors.lastname: Lê
authors.forename: P
authors.initials: P
authors.lastname: Soyer
authors.forename: M
authors.initials: M
authors.lastname: Kardache
authors.forename: R
authors.initials: R
authors.lastname: Rymer
authors.forename: P
authors.initials: P
authors.lastname: Valleur
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging* / Q000628:therapy; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D036542:Tomography, Spiral Computed