Utility Of Multidetector Computed Tomography (mdct) Scan Findings In Surgically Treated Acute Abdomen At Kenyatta National Hospital - Kenya

Abstract

Background: Acute abdomen is the leading cause of exploratory laparotomies in the emergency department. MDCT is the main imaging modality in most cases of acute abdomen and determines those that require surgical management. No studies have been done to show its utility in surgically treated acute abdomen in the region. Methods: A Prospective cross-sectional analytic study was conducted at Kenyatta National Hospital involving 253 consecutive patients with surgically treated acute abdomen over a 12-month period. MDCT findings were compared with surgery and/or histological findings. Results: Pre-surgery MDCT was performed in only 25%. The age range was 18-62 years with median age of 31. The male to female ratio was 3:1.The most common findings at MDCT for trauma were left diaphragmatic rupture with herniation (23.1%), perforated hollow viscera (19.2%) and bladder injury (15.4%); while the most common findings in non-traumatic acute abdomen were acute appendicitis (32.4%), peritonitis (29.7%) and intestinal obstruction (18.9%). MDCT findings showed strong concordance with surgical findings with the overall sensitivity, specificity, NPV, and PPV calculated as 91.7%, 100%, 37.5% and 100% respectively. Surgical findings of patients with acute abdomen were similar in both MDCT and non-MDCT group The total percentage of patients with collections or diagnoses which would have benefited from conservative, limited surgical or interventional radiology managements was 13% and included isolated mild hemoperitoneum, hepatic abscess, negative laparotomy, pancreatitis, pelvic abscess, psoas abscess and sub phrenic abscess. Conclusion: MDCT showed strong concordance with surgical findings with high accuracy, specificity and sensitivity in all types of surgically treated acute abdomen. MDCT is accurate and reliable and should be done in all patients with acute abdomen before surgical intervention, where indicated, to minimize the incidence of exploratory laparotomies.