[Rational diagnostics of acute abdomen].
BACKGROUND
In view of the threat that comes with an acute abdomen, it is of major importance that diagnostics are executed quickly and efficiently. In the course of this two tendencies can be differentiated: 1) general use of complex examination (e.g. CT, MRT) of all potential patients and 2) step-by-step-diagnostics with advanced diagnostics as and when required.


METHODS
A total of 444 patients with an acute abdomen as admission diagnosis were investigated. All data were evaluated prospectively and analyzed retrospectively. All patients had the same basic diagnostics consisting of aclinical history, clinical examination, laboratory examination, abdominal sonography and x-ray overview images. These examinations were supplemented when required by advanced measures, such as CT, colon enema with contrast fluid, endoscopic examination and diagnostic laparotomy.


RESULTS
Three different disease groups of unequal diagnostic need could be identified. The first group, presented in the form of an appendicitis showed that in 80% of all patients a basic diagnosis was sufficient. Advanced examination such as CT affected 14%. The negative appendectomy rate amounted to 8%. Other diseases belonging to the first group were ileus, acute biliary diseases, perforation etc. In the second group presented in the form of a diverticulitis, an advanced radiological examination was required in 84% of all cases. Similar results are also expected in cases of pancreatitis. In the third group presented in the form of coprostasis, inflammatory etiology was found in 39% of all secondary diseases. However the symptoms became clinically apparent after treatment of the coprostasis. In this group a basic diagnosis was satisfactory in 84% of cases, however, a diagnostic laparotomy was inevitable for 3% of these patients.


CONCLUSIONS
Generally step-by-step diagnostic approach has proven itself to be efficient. For 80% of all patients it makes advanced diagnostic measures unnecessary. The exceptions are diseases in which it is necessary to know not only the diagnosis but also the disease stage. In these cases (e.g. pancreatitis, diverticulitis etc.) advanced diagnostics should be pursued from the onset. The necessity of a diagnostic laparotomy has lost importance for 1% of all patients.
Schildberg
C W
CW
Viszeral- und Allgemeinchirurgie, Universität Erlangen/Nürnberg, Deutschland. claus@schildberg.de
Skibbe
J
J
Croner
R
R
Schellerer
V
V
Hohenberger
W
W
Horbach
T
T
D000006:Abdomen, Acute / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis; D002764:Cholecystitis / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D004066:Digestive System Diseases / Q000150:complications* / Q000175:diagnosis*; D004239:Diverticulitis, Colonic / Q000150:complications / Q000175:diagnosis; D005244:Fecal Impaction / Q000150:complications / Q000175:diagnosis; D005260:Female; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D045823:Ileus / Q000150:complications / Q000175:diagnosis; D007511:Ischemia / Q000150:complications / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008643:Mesentery / Q000098:blood supply; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D055815:Young Adult
Scand J Gastroenterol. 2006 Oct;41(10):1126-31
16990196
Ned Tijdschr Geneeskd. 2004 Dec 11;148(50):2474-80
15638193
Zentralbl Chir. 1998;123 Suppl 4:29-31
9880867
Dig Surg. 2008;25(5):394-9
19065056
World J Surg. 2007 Jan;31(1):86-92
17180556
Nig Q J Hosp Med. 2008 Jul-Sep;18(3):170-4
19062484
J Med Syst. 2002 Oct;26(5):465-77
12182210
Colorectal Dis. 2007 Jul;9(6):496-501; discussion 501-2
17573742
Surgery. 2000 Aug;128(2):145-52
10922984
Surg Endosc. 2006 Jan;20(1):14-29
16247571
Chirurg. 1999 Jul;70(7):823-9
10448594
Surg Infect (Larchmt). 2004 Fall;5(3):243-52
15684795
Zentralbl Chir. 1998;123 Suppl 4:46-9
9880872
Chirurg. 1996 Mar;67(3):254-60
8681700
Health Technol Assess. 2006 Nov;10(47):1-167, iii-iv
17083855
Radiology. 2006 Oct;241(1):175-80
16928971
World J Surg. 2007 Dec;31(12):2347-54; discussion 2355-8
17896131
BMJ. 2009 Jun 26;338:b2431
19561056
Ann Surg. 1975 Jun;181(6):853-6
1138636
Eur Radiol. 2002 Sep;12(9):2136-50
12195463
Surgery. 2008 Aug;144(2):276-82
18656636