Appropriate Use of Imaging for Acute Abdominal Pain

Schifeling, Christopher H.; Williams, David A.

doi:10.1001/jamainternmed.2017.6135

Cited by 4 publications

(2 citation statements)

References 6 publications

(22 reference statements)

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“…CT is an important tool in the diagnosis and differential diagnosis of acute appendicitis. [9][10][11] Sinnott and Howlett reported a case of a 38-year-old man with acute appendicitis who presented with atypical clinical symptoms and underwent a CT scan, which showed a dilated, thick walled appendix, confirming the diagnosis of acute appendicitis. 12 Previous studies for patients with acute appendicitis have shown that CT has a high level of diagnostic accuracy that is unaffected by the percentage of female participants, adopted scanning protocol or patient presentation.…”

Section: Discussionmentioning

confidence: 99%

A Patient with Acute Abdominal Pain Caused by an Unnoticed Swallowed Toothpick Misdiagnosed as Acute Appendicitis

2022

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The differential diagnosis of acute abdominal pain is a challenging task for medical doctors working in the department of gastroenterology. It is clear that acute abdominal pain may be associated with a number of pathologic conditions. We report an unusual case of an unnoticed swallowed wooden toothpick stuck in the ileocecal area of a young man with right lower abdominal pain who was misdiagnosed as acute appendicitis. However, an abdominal computed tomography scan showed an elongated foreign body stuck in the ileocecal area. The elongated foreign body was identified as a wooden toothpick, which was then grasped with a foreign body forceps and successfully removed through colonoscopy. The patient’s abdominal pain was significantly relieved within 2 days following treatment. On the basis of the case report, we suggest the importance of abdominal computed tomography scans for the differential diagnosis of acute abdominal pain and highlight the need for extra vigilance in excluding the diagnosis of foreign bodies in the gastrointestinal tract of patients with acute abdominal pain.

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Section: Discussionmentioning

confidence: 99%

A Patient with Acute Abdominal Pain Caused by an Unnoticed Swallowed Toothpick Misdiagnosed as Acute Appendicitis

2022

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“…In addition to increased costs 7 and exposure to ionizing radiation 8,9 , unnecessary examiantions may lead to incidental findings, which in turn may trigger a cascade of events involving further testing or medical procedures, of little benefit to patients 26,27 .…”

Section: Discussionmentioning

confidence: 99%

Abdominal Computed Tomography in the Emergency Room: Overuse of Medical Technologies and the Depreciation of Clinical Diagnosis

Silva

Oliveira

Prado

et al. 2019

Rev. bras. educ. med.

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The number of computed tomography (CT) examinations performed in urgent care has been increasing since its introduction in the emergency room (ER). This has led to a substantial increase in hospital costs and patient’s exposure to ionizing radiation, which has led to the need for more judicious use of CT in the ER. The aim of this study is to show the difference between clinical (pre-CT), tomographic (post-CT) and definitive diagnoses in patients with abdominal CT in the ER. This is a cross-sectional study, with retrospective data collection through electronic medical records. A total of 834 patients with acute abdominal pain (AAP) lasting less than 7 days, submitted to abdominal computed tomography between January 1, 2016 and December 31, 2017 were selected. Clinical, tomographic and final diagnoses were recorded and submitted to a concordance analysis by calculating the Kappa coefficient, considering p <0.05 as significant. CT scans were considered unnecessary when the clinical diagnosis was concordant when both final and post-CT diagnosis were also concordant. The most frequent diagnoses were nonspecific abdominal pain (NSAP), obstructive uropathy (OU) and appendicitis (AP), corresponding to 73.6%, 58.5% and 61.3% of all diagnoses, respectively. Data analysis showed a moderate Concordance for NSAP (kappa: 0.41, p ¬<0.001) and for OU (kappa: 0.46, p <0.001) and excellent for AP (kappa:0.87, p <0.001). In total, 52.6% of computed tomography were considered unnecessary for NSAP, 82.4% for OU and 91.7% for AP. It was concluded that there are high rates of CT that may be considered unnecessary for the diagnosis of the main emergency conditions, especially appendicitis. The study warns to the exaggerated use of CT in the ER and raise discussions over the possible causes, such as lack of confidence in the clinical diagnosis, fear of diagnostic errors and fear of malpractice lawsuits, of which possible solutions may be more effective when applied since the medical education basis.

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What Is the Role of Imaging and Reimaging in Patients with Chronic Abdominal Pain?

Katz

Smereck

2019

Gastrointestinal Emergencies

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Appropriate Use of Imaging for Acute Abdominal Pain

Cited by 4 publications

References 6 publications

A Patient with Acute Abdominal Pain Caused by an Unnoticed Swallowed Toothpick Misdiagnosed as Acute Appendicitis

A Patient with Acute Abdominal Pain Caused by an Unnoticed Swallowed Toothpick Misdiagnosed as Acute Appendicitis

Abdominal Computed Tomography in the Emergency Room: Overuse of Medical Technologies and the Depreciation of Clinical Diagnosis

What Is the Role of Imaging and Reimaging in Patients with Chronic Abdominal Pain?

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