Abstract
In differential diagnosis of acute abdominal pain which is one of the most commonly encountered situations in emergency departments, data in the literature shows variability with regard to diagnostic efficiency of plain abdominal radiography. Radiation dose should be considered especially in pediatric patients and in patients in whom multiple radiographies are required, because radiation dose of plain abdominal radiography (0.7 millisievert) is much higher than that of chest radiography (0.01–0.02 millisievert). In emergency departments, plain radiographies are not usually evaluated by radiologists, by that way; evaluation of radiographies with priority of clinical diagnosis may cause false positive and false negative results. Plain abdominal radiographies have higher diagnostic efficiency especially for intestinal obstruction and gastrointestinal perforation among the other abdominal emergencies. Therefore, plain abdominal radiography should be the first imaging modality in patients with clinical and physical findings compatible with intestinal obstruction and gastrointestinal perforation. However, use of plain abdominal radiography in other acute abdominal pathologies including acute appendicitis does not appear to be appropriate because of inadequate diagnostic efficiency and risk of radiation exposure.
Keywords:
Acute abdominal pain, acute abdomen, abdominal radiography
References
1van Randen A, Laméris W, Luitse JS, et al The role of plain radiographs in patients with acute abdominal pain at the ED. Am J Emerg Med 2011; 29:582–589. doi:10.1016/j.ajem.2009.12.020
2Smith JE, Hall EJ. The use of plain abdominal X rays in the emergency department. Emerg Med J 2009; 26:160–163. doi:10.1136/emj.2008.059113
3Musson RE, Bickle I, Vijay RK. Gas patterns on plain abdominal radiographs: a pictorial review. Postgrad Med J 2011; 87:274–287. doi:10.1136/pgmj.2009.082396
4Böhner H, Yang Q, Franke C, et al. Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain. Eur J Surg 1998; 164:777–784. doi:10.1080/110241598750005435
5Veldkamp WJ, Kroft LJ, Geleijns J. Dose and perceived image quality in chest radiography. Eur J Radiol 2009; 72:209–217. doi:10.1016/j.ejrad.2009.05.039
6Yanch JC, Behrman RH, Hendricks MJ, et al. Increased radiation dose to overweight and obese patients from radiographic examinations. Radiology 2009; 252:128–139. doi:10.1148/radiol.2521080141
7Wall BF, Hart D. Revised radiation doses for typical X-ray examinations. Report on a recent review of doses to patients from medical X-ray examinations in the UK by NRPB. Br J Radiol 1997; 70:437–439.
8Ukrisana P, Yenarkarn P. Evaluation of the necessity of the three-film abdominal series in the diagnosis of abdominal pain. J Med Assoc Thai 2002; 85:998–1002.
9Haller O, Karlsson L, Nyman R. Can lowdose abdominal CT replace abdominal plain film in evaluation of acute abdominal pain? Ups J Med Sci 2010; 115:113–120. doi:10.3109/03009730903294871
10Lim CB, Chen V, Barsam A, et al. Plain abdominal radiographs: can we interpret them? Ann R Coll Surg Engl 2006; 88:23–26. doi:10.1308/003588406X83023
11Boleslawski E, Panis Y, Benoist S, et al. Plain abdominal radiography as a routine procedure for acute abdominal pain of the right lower quadrant: prospective evaluation. World J Surg 1999; 23:262–264. doi:10.1007/PL00013181
12Oncel M, Degirmenci B, Demirhan N, et al. Is the use of plain abdominal radiographs (PAR) a necessity for all patients with suspected acute appendicitis in emergency services? Curr Surg 2003; 60:296–300. doi:10.1016/S0149-7944(02)00732-8
13Prasannan S, Zhueng TJ, Gul YA. Diagnostic value of plain abdominal radiographs in patients with acute abdominal pain. Asian J Surg 2005; 28:246–251. doi:10.1016/S1015-9584(09)60354-7
14Anyanwu AC, Moalypour SM. Are abdominal radiographs still overutilized in the assessment of acute abdominal pain? A district general hospital audit. J R Coll Surg Edinb 1998; 43:267–270.
15Grassi R, Romano S, Pinto A, et al. Gastroduodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol 2004; 50:30–36. doi:10.1016/j.ejrad.2003.11.012
16Tasu JP, Takun K, Rocher L, et al. Evaluation of plain abdominal radiography prescriptions in a university hospital center. Presse Med 2001; 30:1097–1101.
17Nagurney JT, Brown DF, Novelline RA, et al. Plain abdominal radiographs and abdominal CT scans for nontraumatic abdominal pain--added value? Am J Emerg Med 1999; 17:668–671. doi:10.1016/ S0735-6757(99)90155-9
18Ashindoitiang JA, Atoyebi AO, Arogundade RA. The value of plain abdominal radiographs in management of abdominal emergencies in Luth. Nig Q J Hosp Med 2008; 18:170–174
19Rothrock SG, Green SM, Hummel CB. Plain abdominal radiography in the detection of major disease in children: a prospective analysis. Ann Emerg Med 1992; 21:1423–1429. doi:10.1016/ S0196-0644(05)80053-8
20Bansal J, Jenaw RK, Rao J, et al. Effectiveness of plain radiography in diagnosing hollow viscus perforation: study of 1,723 patients of perforation peritonitis. Emerg Radiol 2011.
21Thorsen K, Glomsaker TB, von Meer A, et al. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg 2011; 15:1329–1335. doi:10.1007/ s11605-011-1482-1
22Ulukaya Durakbaşa C, Taşbaşi I, Tosyali AN, et al. An evaluation of individual plain abdominal radiography findings in pediatric appendicitis: results from a series of 424 children. Ulus Travma Acil Cerrahi Derg 2006; 12:51–58.
23Türkyilmaz Z, Sönmez K, Konus O, et al. Diagnostic value of plain abdominal radiographs in acute appendicitis in children. East Afr Med J 2004; 81:104–107. doi:10.4314/eamj.v81i2.9134
24Petroianu A, Alberti LR. Importance of the new radiographic sign of fecal loading in the cecum in the presence of acute appendicitis in comparison with other inflammatory diseases of the right abdomen. Eur J Intern Med 2008; 19:22–26. doi:10.1016/j.ejim.2007.04.021
