Plain abdominal radiography in acute abdominal pain; past, present, and future

Abstract

Several studies have demonstrated that a diagnosis based solely on a patient’s medical history, physical examination, and laboratory tests is not reliable enough, despite the fact that these aspects are essential parts of the workup of a patient presenting with acute abdominal pain. Traditionally, imaging workup starts with abdominal radiography. However, numerous studies have demonstrated low sensitivity and accuracy for plain abdominal radiography in the evaluation of acute abdominal pain as well as various specific diseases such as perforated viscus, bowel obstruction, ingested foreign body, and ureteral stones. Computed tomography, and in particular computed tomography after negative ultrasonography, provides a better workup than plain abdominal radiography alone. The benefits of computed tomography lie in decision-making for management, planning of a surgical strategy, and possibly even avoidance of negative laparotomies. Based on abundant available evidence, major advances in diagnostic imaging, and changes in the management of certain diseases, we can conclude that there is no place for plain abdominal radiography in the workup of adult patients with acute abdominal pain presenting in the emergency department in current practice.

Imaging of Ischemia, Obstruction and Infection in the Abdomen

“…It has a reported sensitivity of 69-80% for bowel obstruction [12][13][14][15] but is insensitive in assessing for complications or etiology. In addition, abdominal radiographs are neither sensitive nor specific for detection of intestinal ischemia or infectious/inflammatory conditions such as diverticulitis, colitis or appendicitis.…”

The new chest x ray

“…The limitations of the abdominal x ray in patients with acute abdominal pain are now widely accepted, as the greater use of ultrasound,5 and particularly CT scanning, has made its deficiencies glaringly apparent. X rays of the spine for trauma or back pain are now indicated only in specific circumstances according to recent guidance,6 replaced when necessary by CT or magnetic resonance imaging in selected patients when imaging is essential to managing their treatment.…”

Will Plain Abdominal Radiographs become Obsolete?

“…16 Abdominal and pelvis radiographs require approximately 0.7 mSv each. 17 The average dose for CT Abdomen/ Pelvis is between 10 and 24 mSV. 18,19 However, a recent study showed that the median effective dose for CT scan of a multiphase abdomen and pelvis is 31 mSV.…”