Clinical, laboratory, and imaging predictors of surgical exploration in nontraumatic acute abdomen

Abstract

Introduction: Acute abdominal pain (AAP) accounts for a substantial proportion of patients arriving at a surgical emergency department. As AAP may be caused by both life-threatening diseases and conditions that are spontaneously resolved, a correct diagnosis is of importance for the prognosis of the patient. Materials and Methods: Clinical, laboratory, and imaging studies were done in patients presenting with a history of acute, nontraumatic pain in the abdomen in the Department of Surgery of NKP SIMS and Lata Mangeshkar Hospital, Nagpur, over a period of 2 years. Results: A total of 400 patients with a mean age of 38.05 ± 11.45 with a male: female ratio of 2.07:1 were enrolled. Of them, 233 patients underwent exploration and 167 were managed conservatively. During univariate analysis, age group, pulse rate, temperature, hemoglobin, total leukocyte count (TLC), tenderness, guarding, distension, bowel sounds, chest radiograph, and abdominal radiograph were found to be significant. On multivariate analysis, hemoglobin, TLC, tenderness, distension, and abdomen radiograph were significantly associated with exploration. Conclusion: In a patient of nontraumatic acute abdomen, clinical predictors such as tenderness and distension, laboratory predictors such as hemoglobin and TLC, and abdominal standing radiograph as an imaging predictor were the most statistically significant for exploration.