title: The role of computed tomography in the preoperative assessment of gastrointestinal causes of acute abdomen in elderly patients.
abstract: Gastro-intestinal disorders in older patients is a medical emergency that requires immediate medical care. Chances of recovery improve with an early diagnosis and treatment. It might be caused by a number of different diseases, including perforations by foreign bodies, colon cancer, diverticulitis, ischemia. CT is often the initial modality used to assess patients with acute abdomen, the radiologist may be the first to suggest such a diagnosis. Computed tomography allows to identify the site of gastrointestinal perforations, of ischemia and to determine the most predictive signs in this diagnosis. The purpose of this study was to assess the diagnostic performance of CT gastrointestinal emergency of elderly patients with nontraumatic acute abdominal pain. The cases of 126 consecutively registered patients 65 years old or older presenting to the emergency department with acute abdominal pain and who underwent CT were retrospectively reviewed by two radiologists. Diagnostic accuracy was calculated according to the level of correctly classified cases in both the entire cohort and a surgical subgroup and was compared between readings. Agreement between each reading and the reference diagnosis and interobserver agreement were assessed with kappa statistics. In both the entire cohort (87.5% vs 85.3%, p = 0.07) and the surgical group (94% vs 91%, p = 0.15), there was no significant difference in CT accuracy between diagnoses made by the radiologist. Agreement between the CT diagnosis and the final diagnosis was excellent. In the care of elderly patients, CT is accurate for diagnosing the cause of acute abdominal pain, particularly when it is of gastrointestinal surgical origin. Thus CT interpretation should not be delayed until complete clinicobiologic data are available, and the images should be quickly transmitted to the emergency physician so that appropriate therapy can be begun.
authors.affiliation: Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy. Electronic address: alfonso.reginelli@unina2.it.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Reginelli
authors.affiliation: Department of Radiology, S.G. Moscati Hospital, Aversa, Italy. Electronic address: annarusso81@yahoo.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Russo
authors.affiliation: Department of Radiology, A. Cardarelli Hospital, Naples, Italy. Electronic address: antopin1968@libero.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
authors.affiliation: Department of General and Emergency Surgery, Metabolic Care, Clinic Pineta Grande, Castel Volturno, Caserta, Italy. Electronic address: fstanzione@yahoo.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Stanzione
authors.affiliation: Department of Radiology, S.G. Moscati Hospital, Aversa, Italy. Electronic address: ciromartiniello@tin.it.
authors.forename: Ciro
authors.initials: C
authors.lastname: Martiniello
authors.affiliation: Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy. Electronic address: salvatore.cappabianca@unina2.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cappabianca
authors.affiliation: Department of Health Science, University of Molise, Campobasso, Italy. Electronic address: lucabrunese@libero.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Brunese
authors.affiliation: Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome Tor Vergata, Rome, Italy. Electronic address: ettoresquillaci@tiscali.it.
authors.forename: Ettore
authors.initials: E
authors.lastname: Squillaci
mesh_terms: D000006:Abdomen, Acute / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D004238:Diverticulitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D004636:Emergency Service, Hospital; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging*; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D065666:Mesenteric Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
keywords: Acute abdomen; CT; Elderly patients; Gastrointestinal emergencies