Diagnostic Errors of Non-Traumatic Acute Abdomen

Abstract

background: Acute abdomen is a relatively common issue that facing hospital casualties, which make it crucial for physicians to diagnose acute abdomen, as early as possible depending mainly on their clinical skills to avoid unnecessary delay or negative laparotomies. Every physician must be familiar with diagnosis of acute abdomen especially in situations where there is limited diagnostic facilities.Aim: This study was conducted as a comparison between preliminary and final diagnosis for 500 cases of acute abdomen, and to find out the role of clinical skill and diagnostic tools in avoiding diagnostic errors.Method: This study was performed from 1996-1998, and included 500 patients presented to casualty department with signs and symptoms of acute abdomen. Clinical skills were the major tools used for settling the diagnosis, due to shortage of the other diagnostic tools.Results: Acute abdomen was common in the age group of 21-30 years, with male gender predominance (60.80%). Laparotomy was done for 462 out of 500 patients with acute abdomen, and it was similar to the pre-operative diagnosis in 421 patients, so the incorrect post-operative diagnosis rate was 41 patients (8.88%).Also correct preliminary diagnosis was 454 out of 500 patient including the patients who underwent laparotomy, with false preliminary diagnosis rate (9.20%).Appendicitis was the major cause for acute abdomen (70.60%).Limited laboratory and imaging studies were done for some patients, GUE showed the highest negative predicted value (99.42%) and the x-ray showed the highest sensitivity (95.24%). Most of incorrect post-operative diagnosis was related to physiological and pathological gynecological issues.Conclusion: The diagnosis of acute abdomen should be based on the results of a good history and thorough physical examination aided by the secondary role of investigative tools. Diagnostic modalities could guide the physician in confirming the diagnosis. An accurate diagnosis of acute abdomen can minimize unnecessary operations and reduces the rate of negative laparotomies.Keywords: Acute abdomen, Laparotomy, Diagnosis