Acute abdominal pain in the elderly patient: Impact of early MDCT examination on diagnosis and management

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1 Acute abdominal pain in the elderly patient: Impact of early MDCT examination on diagnosis and management Poster No.: C-1464 Congress: ECR 2010 Type: Topic: Scientific Exhibit GI Tract Authors: A. Pinto, A. Sparano, N. Gagliardi, S. Daniele, G. Ponticiello, G. Russo, L. Romano; Naples/IT Keywords: DOI: Acute abdomen, elderly patient, Computed Tomography /ecr2010/C-1464 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9

2 Purpose To assess the role of Multidetector row Computed Tomography (MDCT) when early performed in the diagnostic process and management of elderly patients with acute abdomen of non traumatic origin. Methods and Materials We performed a retrospective review of 320 patients (141 men and 179 women, years old) who presented to our Emergency Department with acute abdominal pain and underwent contrast enhanced MDCT scanning within 12 hours after admission. MDCT was performed before and after intravenous contrast agent (120 ml) rapid infusion (3 ml/s) and using a power injector. Iodine contrast agent was administered intravenously with the following parameters: volume,120 ml; rate, 2-3 ml/s; concentration 400 mgi/ml (Iomeron 400/Bracco/Italy). A biphasic postcontrastographic study was performed in all patients. MDCT examination was evaluated by two expert radiologists (with 15 years experience in abdominal radiology and CT) using axial image and multiplanar reconstruction (MPR), coronal, sagittal, or oblique according to the localization of the disease; cases of disagreement were reviewed jointly, with the evaluation of a third experienced radiologist. The diagnoses obtained at MDCT examination were compared with the final surgical or non surgical diagnosis. Results At MDCT examination, the following diagnoses were made: bowel obstruction (n=72) (Fig. 1), diverticulitis (n=41) (Fig. 2), urolithiasis (n=33), gastrointestinal tract perforation (n=30) (Fig. 3), appendicitis (n=29), cholecystitis (n=25), pancreatitis (n=23), pelvic inflammatory disease (n=10), abdominal aortic aneurysm (n=8), ischemic bowel disease (n=6), and miscellaneous (n=6). Page 2 of 9

3 CT examination was interpreted as negative in the remaining 37 patients. After MDCT examination 165 patients had a medical treatment and were discharged after 6 hours. In 9 cases (2.8%) an incorrect diagnosis was reported leading to 5 unnecessary laparotomies. Images for this section: Page 3 of 9

4 Page 4 of 9

5 Fig. 1: A 70-year old man with acute abdominal pain. MDCT (coronal reconstruction) of the abdomen shows a small bowel obstruction. Fig. 2: A 67-year old man with acute abdominal pain. MDCT scan reveals an acute complicated diverticulitis surgically confirmed. Page 5 of 9

6 Page 6 of 9

7 Fig. 3: A 72-year old man with abdominal aortic aneurysm. MDCT (sagittal reconstruction) of the abdomen shows a colonic ischemia associated with perforation. Page 7 of 9

8 Conclusion Accumulating data indicate that abdominal CT scanning, particularly if enhanced with intravenous contrast material, may improve the management of patients with acute abdominal pain [1-8]. The clinical difficulty in evaluating the patient with abdominal pain, especially the elderly patient, is well known. This is a subset of patients who may have minimal findings at physical examination yet may harbor significant pathology, some of which may require urgent intervention [9-10]. MDCT is particularly useful when performed early in the diagnostic process of elderly patients with acute abdomen because allows a fast diagnosis and a timely treatment. References 1.Gore RM, Miller FH, Pereles FS, et al. (2000) Helical CT in the evaluation of the acute abdomen. AJR Am J Roentgenol 174: Ng CS, Watson CJE, Palmer CR, et al. (2002) Evaluation of early abdominopelvic computed tomography inpatients with acute abdominal pain of unknown cause: prospective randomised study. BMJ 325: Rosen MP, Siewert B, Sands DZ, et al. (2003) Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 13: Salem TA, Molloy RG, O'Dwyer PJ (2005) Prospective study on the role of the CT scan in patients with an acute abdomen. Colorectal Dis 7: Dalzell DP, Scharling ES, Ott DJ, et al. (1998) Acute pancreatitis: the role of diagnostic imaging. Crit Rev Diagn Imaging 39: Khurana B, Ledbetter S, McTavish J, et al. (2002) Bowel obstruction revealed by multidetector CT. AJR Am J Roentgenol 178: Page 8 of 9

9 7. Delabrousse E, Destrumelle N, Brunelle S, et al. (2003) CT of small bowel obstruction in adults. Abdom Imaging 28: Taourel P, Kessler N, Lesnik A, et al. (2003) Helical CT of large bowel obstruction. Abdom Imaging 28: Miller JA, Abu-Judeh H, Ahmad I (1998) The utility of urgent abdominal Computed Tomography in the elderly patient. Emerg Radiol 5: Pinto A, Scaglione M, Pinto F et al. (2000) Helical computed tomography diagnosis of gastrointestinal perforation in the elderly patient. Emerg Radiol 7: Personal Information Antonio Pinto, MD, PhD Department of Radiology (Chief: Dr. Luigia Romano) Cardarelli Hospital Naples, Italy e.mail: Amelia Sparano, Nicola Gagliardi, Stefania Daniele, Gianluca Ponticiello, Giovanna Russo, Luigia Romano Department of Radiology (Chief: Dr. Luigia Romano) Cardarelli Hospital Naples, Italy Page 9 of 9

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