The role of computed tomography in the preoperative assessment of gastrointestinal causes of acute abdomen in elderly patients.
Gastro-intestinal disorders in older patients is a medical emergency that requires immediate medical care. Chances of recovery improve with an early diagnosis and treatment. It might be caused by a number of different diseases, including perforations by foreign bodies, colon cancer, diverticulitis, ischemia. CT is often the initial modality used to assess patients with acute abdomen, the radiologist may be the first to suggest such a diagnosis. Computed tomography allows to identify the site of gastrointestinal perforations, of ischemia and to determine the most predictive signs in this diagnosis. The purpose of this study was to assess the diagnostic performance of CT gastrointestinal emergency of elderly patients with nontraumatic acute abdominal pain. The cases of 126 consecutively registered patients 65 years old or older presenting to the emergency department with acute abdominal pain and who underwent CT were retrospectively reviewed by two radiologists. Diagnostic accuracy was calculated according to the level of correctly classified cases in both the entire cohort and a surgical subgroup and was compared between readings. Agreement between each reading and the reference diagnosis and interobserver agreement were assessed with kappa statistics. In both the entire cohort (87.5% vs 85.3%, p = 0.07) and the surgical group (94% vs 91%, p = 0.15), there was no significant difference in CT accuracy between diagnoses made by the radiologist. Agreement between the CT diagnosis and the final diagnosis was excellent. In the care of elderly patients, CT is accurate for diagnosing the cause of acute abdominal pain, particularly when it is of gastrointestinal surgical origin. Thus CT interpretation should not be delayed until complete clinicobiologic data are available, and the images should be quickly transmitted to the emergency physician so that appropriate therapy can be begun.
['Reginelli|Alfonso|A|', 'Russo|Anna|A|', 'Pinto|Antonio|A|', 'Stanzione|Francesco|F|', 'Martiniello|Ciro|C|', 'Cappabianca|Salvatore|S|', 'Brunese|Luca|L|', 'Squillaci|Ettore|E|']
D000006:Abdomen, Acute D015746:Abdominal Pain D000368:Aged D000369:Aged, 80 and over D002277:Carcinoma D015331:Cohort Studies D015179:Colorectal Neoplasms D004238:Diverticulitis D004636:Emergency Service, Hospital D005260:Female D005547:Foreign Bodies D041981:Gastrointestinal Tract D006801:Humans D007416:Intestinal Perforation D008297:Male D065666:Mesenteric Ischemia D012189:Retrospective Studies D012680:Sensitivity and Specificity D014057:Tomography, X-Ray Computed
Acute abdomen Elderly patients CT Gastrointestinal emergencies