The problem-solving role of the 'wait and repeat CT' approach in the diagnosis and treatment of acute abdomen.

Background: This study aims to assess the diagnostic value and problem-solving utility of follow-up abdominopelvic computed tomography (CT) scans performed within 10 days of the initial presentation for acute non-traumatic abdominal symptoms in the emergency department.

Methods: A retrospective analysis was conducted on patients who presented with acute abdominal symptoms to the emergency department between January 1, 2013 and May 30, 2023, and underwent abdominopelvic CT scans in the acute setting. Among this cohort, 149 patients had repeat abdominopelvic CT scans during the same admission and were classified into five groups based on findings: Group A (no change in diagnosis), Group B (confirmation of suspected initial diagnosis), Group C (disease progression), Group D (disease regression), and Group E (new diagnosis).

Results: The mean age of the cohort was 51.5+-18 years (range: 19-92). The average interval between initial and repeat CT scans was 40.9+-59.05 hours (range: 0.5-238). The number of patients in each group was as follows: Group A (n=21), Group B (n=60), Group C (n=32), Group D (n=25), and Group E (n=11). Partial bowel obstruction was the most common finding (27%, 41/149), with 72% (18/25) of Group D showing regression on follow-up CT. The "wait and follow-up" approach significantly guided management decisions for partial bowel obstruction (p<0.01).

Conclusion: This study emphasizes the importance of the "wait and repeat CT" strategy in enhancing diagnostic accuracy and guiding clinical management for patients with acute non-traumatic abdominal complaints. Follow-up CT scans were particularly effective in identifying conditions such as partial bowel obstruction.