• Cecilia Strömberg, Gunnar Johansson, and Anders Adolfsson.
• Department of Surgery, Karolinska University Hospital at Huddinge and Capio St Göran's Hospital, SE-141 86, Stockholm, Sweden. cecilia.stromberg@karolinska.se
• World J Surg. 2007 Dec 1; 31 (12): 2347-54; discussion 2355-8.

BackgroundAcute abdominal pain is a common diagnostic problem. This study aimed to evaluate the routinely use of contrast enhanced computed tomographic (CT) scanning early in the diagnostic process.MethodsA retrospective review of 2,222 patients with acute abdominal pain who underwent contrast enhanced CT scanning within 24 h after admission. The diagnoses obtained were compared with the final diagnoses after 1 month.ResultsAfter CT scanning the following diagnoses were suggested as the primary cause of the abdominal pain: nonspecific abdominal pain 984 (44.3%), appendicitis 354 (15.9%), bowel obstruction 190 (8.6%), diverticulitis 182 (8.2%), gastrointestinal perforation 52 (2.3%), gallstone disease 64 (2.9%), pancreatitis 72 (3.2%), inflammatory bowel disease 13 (0.6%), intra-abdominal malignancy 34 (1.5%), vascular disease (including 1 completely cured patient with paradoxical embolization in the superior mesenteric artery) 33 (1.5%), urological 131 (5.9%), gynecological 54 (2.4%), miscellaneous 31 (1.4%). In 28 cases a conclusive CT examination could not be carried out. The suggested diagnoses were correct in 2,151 cases (96.8%). In 16 cases (0.7%) an incorrect diagnosis was reported, leading to 7 unnecessary laparotomies. False negative reports were obtained in 27 cases (1.2%). After CT examination 500 patients could be discharged immediately.ConclusionsContrast-enhanced CT scanning results in superior diagnostic precision in patients with acute abdominal pain. The present work supports the strategy to include this examination early in the routine diagnostic process.

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