WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Dr Mohammed Ibraheem Abbas*, Dr Ismail Hasan Khudhair, Dr Omar Fadhil Abbas

ABSTRACT

Background: Acute abdominal pain is a common presentation that requires in most cases immediate management. It is sometimes crucial to reach a diagnosis at the onset and to make a decision as to operate if needed. 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. This study is to compare the accuracy of preoperative diagnosis in the acute abdominal cases and find most common causes of acute abdomen. To see the negative laparotomy rate and diagnostic accuracy and predictive values of different investigations in acute abdomen. Patients & Methods: This was an observational prospective study, conducted from February to December 2011.The study included 343 patients referred to 3rd surgical unit in Baghdad Teaching Hospital, presented with symptoms and signs of acute abdomen. Any patient aged above 14 years was included. All patients operated as a case of acute appendicitis had Alvarado score of more than 7. The patients with acute pancreatitis included those not responding to medical treatment or rapidly deteriorating or have suspicion of necrotizing pancreatitis. Results: All 343 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 (53.06%) was the most common cause of the surgical condition followed by peritonitis (19.8%), bowel obstruction (13.9%), pancreatitis (3.79%), gall bladder diseases (2.9%), complicated ovarian cyst (4.37%) and ectopic pregnancy (2.04%) in female patients. The negative laparotomy rate was 9.23% (P value < 0.05). In 286 (83.38%) of patients, the pre and post laparotomy diagnoses were the same. The diagnostic accuracy rates were 90.6%. In our study total WBCs had the highest sensitivity (87%) and abdominal X-ray had the highest specificity (88.8%).The highest positive predictive value was related to abdominal x-ray (88.6%), while urinalysis showed the highest negative predictive value (93.3%). Conclusion: It is true that the diagnosis of acute abdomen is based on history, clinical examination and investigation; nevertheless it is rather clinical in most of the case. The most common cause of acute abdomen by far was acute appendicitis followed by peritonitis and bowel obstruction. The accuracy of clinical diagnosis was quite significant in acute appendicitis and significant in peritonitis. The rest of surgical conditions contributing to acute abdomen did not show statistically significant diagnostic accuracy. The reason for that lies in the fact that the number of cases studied for them were inadequate to refute any statistical chance factors.