J Korean Soc Emerg Med.  2017 Dec;28(6):665-675. 10.0000/jksem.2017.28.6.665.

Analysis of Differential factors for Detecting Surgical Acute Abdomen in Women of Childbearing Age Presenting to the Emergency Department with Non-traumatic Abdominal Pain in the Absence of Laboratory Abnormalities

• Song HJ
• Lee JH

• KMID: 2403287
• DOI: http://doi.org/10.0000/jksem.2017.28.6.665

Abstract

PURPOSE
Acute abdomen in women of childbearing age has a broad differential diagnosis, often presenting a diagnostic challenge to an emergency physician. Computed tomography (CT) has been used for an accurate diagnosis and prompt treatment of acute abdomen. On the other hand, the increasing use of CT has been a subject of concern for patients, particularly women of childbearing age, due to the potential risk of radiation exposure. This study analyzed the efficacy of various physical examinations for detecting surgical acute abdomen in women of childbearing age who presented with non-traumatic abdominal pain in the absence of laboratory abnormalities.
METHODS
The charts and CT reports of women, aged 15-35 years old, who visited our ED for non-traumatic abdominal pain between May 2011 and April 2017 were reviewed retrospectively. Patients with chronic abdominal disease, pregnancy, recent abdominal surgery within one month, and abnormal laboratory tests were excluded.
RESULTS
In total, 121 patients were identified, of which 34 patients fell into a group that required surgical intervention (surgical acute abdomen group). The remaining 87 patients were managed conservatively without surgical intervention (non-surgical acute abdomen group). The maximal tenderness point (p=0.006), rebound tenderness (p=0.001), shorter duration of abdominal pain (p < 0.001), and absence of diarrhea (p=0.001) were statistically significant for predicting the need for surgical intervention.
CONCLUSION
In the absence of abnormal laboratory studies, the hypogastrium tenderness point, rebound tenderness, duration of abdominal pain, and diarrhea were found to be independently valid factors for detecting surgical acute abdomen in women of childbearing age who presented with non-traumatic abdominal pain.

Keyword

Acute abdomen; Women; Abdominal pain; Hospital emergency services; Laboratories

MeSH Terms

Abdomen, Acute*
Abdominal Pain*
Diagnosis
Diagnosis, Differential
Diarrhea
Emergencies*
Emergency Service, Hospital*
Female
Hand
Humans
Physical Examination
Pregnancy
Radiation Exposure
Retrospective Studies