Rol de las imágenes en la patología arterial no ateroesclerótica poco frecuente en el abdomen / Role of images in rare vascular pathology in the abdomen

Resumen La patología arterial no ateromatosa constituye un grupo de patologías poco frecuentes, pero de gran importancia debido a su morbilidad y mortalidad asociadas. La presentación clínica de estas entidades es inespecífica, por lo que el estudio inicial con imágenes es fundamental. Debido a esto, es muy importante reconocer los signos radiológicos característicos de cada una en las diversas modalidades imagenológicas para poder sospechar y orientar el diagnóstico.

Abstract Non-atheromatous arterial pathology constitutes a group of infrequent pathologies but of great importance due to their associated morbidity and mortality. In general, the clinical presentation of these pathologies is quite nonspecific, so the clinician decides to perform imaging studies thinking of more common entities. It is for this reason that it is very important to recognize characteristic radiological signs in the various imaging modalities to be able to suspect and orient a pathology of this kind.

Ultrasonografía eficaz, seguimiento del paciente con dolor abdominal agudo y diagnóstico presuntivo de apendicitis / Effective ultrasonography, monitoring the patient with acute abdominal pain and appendicitis presumptive diagnosis

RESUMEN Introducción: La ultrasonografía es un procedimiento que utiliza ondas de sonido de alta energía para estudiar tejidos y órganos, formándose imágenes que permiten diagnosticar enfermedades. La eficacia en su implementación es útil para determinar acciones de intervención en procesos de salud. Objetivo: Determinar la eficacia del uso de la ultrasonografía asociada a características clínicas y epidemiológicas en pacientes con dolor abdominal agudo por apendicitis en el Centro Médico "Popular" Vinces. Métodos: Se realizó un estudio correlacional, descriptivo, de cohorte retrospectivo realizado durante 7 meses (enero a julio del 2019). La población estuvo constituida por 162 pacientes, se incluyó, además, a derivados con dolor abdominal agudo diagnosticados con apendicitis a través de la clínica y/o ultrasonografía del Centro Médico "Popular" Vinces. Resultados: De los 162 pacientes observados se intervinieron 157, diagnóstico anatomopatológico de apendicitis en 130. La sensibilidad de la ecografía con criterio de certeza y sospecha fue 96,7 por ciento. La muestra aleatoria piloto contenía 162 participantes de un total de 180 pacientes, mujeres (16,67 por ciento) y hombres (83,33 por ciento). Conclusiones: Se demostró que la ecografía abdominal es el método diagnóstico eficaz, de elección para este estudio por su sensibilidad y criterio de certeza, fácil acceso y costo mínimo, permitiéndose un control adecuado y seguimiento preventivo de las complicaciones, más aún en los casos, con cuadro clínico y laboratorio dudoso, con el fin de evitar posibles complicaciones y reducir los costos económicos durante su diagnóstico(AU)

ABSTRACT Introduction: This article is an extensive review of the different aspects of this pathology, acute appendicitis despite being the first cause of emergency abdominal surgery, the delay in diagnosis implies an increase in surgical interventions with perforated appendices and, therefore, an increase in morbidity and mortality. Objective: To present the results of the efficacy of the use of ultrasonography associated with clinical and epidemiological characteristics in patients with acute abdominal pain due to appendicitis at the "popular" Medical Center Vinces-Ecuador. Methods: A correlational, descriptive, Retrospective cohort study conducted for 7 months (January to July 2019), in which the study population included patients referred with acute abdominal pain diagnosed with appendicitis through the clinic and / or ultrasonography of the "popular" Vinces Medical Center, Ecuador. This population is constituted by 162 patients. Results: Of the 162 patients observed, 157 underwent surgery, an anatomopathological diagnosis of appendicitis in 130. The sensitivity of the ultrasound with criteria of certainty and suspicion was 96.7 percent. The pilot random sample contained 162 participants out of a total of 180 patients, women (16.67 percent) and men (83, 33 percent). Conclusion: it was shown that abdominal ultrasound is the effective diagnostic method of choice for this study because of its sensitivity and certainty, easy access and minimal cost, allowing adequate control and preventive monitoring of complications, even more so in cases, with symptoms. clinical and laboratory doubtful, in order to avoid possible complications and reduce economic costs during diagnosis(AU)

Abdominal symptoms as initial manifestation of COVID-19: a case series / Sintomas abdominais como manifestação inicial da COVID-19: uma série de casos

ABSTRACT The COVID-19 became a pandemic in early 2020. It was found, at first, that the main manifestations of this new virus occur through respiratory and constitutional symptoms. Therefore, chest tomography was elected as the best imaging test to assess the extent of pulmonary involvement and as a good prognostic predictor for the disease. However, as new studies were produced, the gastrointestinal involvement of COVID-19 becomes more evident, with reports from patients who manifested mainly or only gastrointestinal symptoms in the course of the disease. Thus, in some cases, the initial investigation is carried out at the emergency department with an abdominal computed tomography. We report a case series of ten patients who came to the emergency department of our institution with a chief gastrointestinal complaint, and were initially submitted to an abdominal computed tomography as the first investigation. Although most of the patients did not have significant changes in the abdominal images, most reported patients had pulmonary findings visualized at the lung bases, which were later designated as typical COVID-19 pulmonary findings on chest computed tomography. Only one patient had atypical COVID-19 lung changes on chest computed tomography. All patients had a positive real-time polymerase chain reaction for COVID-19. It is imperative to alert radiologists, especially abdominal radiologists, with the possibility of COVID-19 isolated gastrointestinal symptoms. Besides, it must become a habit to radiologists to assess the pulmonary basis on abdominal scans, a site commonly affected by the new coronavirus.

RESUMO A COVID-19 foi declarada uma pandemia no início de 2020. Constatou-se, inicialmente, que as principais manifestações desse novo vírus ocorrem por meio de sintomas respiratórios e constitucionais. A tomografia do tórax foi eleita o exame de imagem para avaliar a extensão do comprometimento pulmonar e como um fator preditivo do prognóstico para a doença. No entanto, à medida que novos estudos são produzidos, o envolvimento gastrointestinal da COVID-19 torna-se mais evidente, com relatos de pacientes que manifestaram principalmente ou apenas sintomas gastrointestinais no decorrer da doença. Em alguns casos, a investigação inicial é realizada no pronto-socorro, com tomografia computadorizada do abdome. Relatamos uma série de casos de dez pacientes que compareceram ao serviço de emergência da instituição com uma queixa principal gastrointestinal e foram submetidos inicialmente a uma tomografia computadorizada de abdome como primeira investigação. Embora a maioria dos pacientes não tenha apresentado alterações significativas nas imagens abdominais, eles apresentaram achados pulmonares visualizados nas bases pulmonares, que depois foram caracterizadas como achados pulmonares típicos de COVID-19 nas tomografias de tórax subsequentes. Apenas um paciente apresentou achados atípicos para COVID-19 na tomografia. Todos os pacientes tiveram reação em cadeia da polimerase em tempo real positiva para o novo coronavírus. É muito importante alertar os radiologistas, principalmente os radiologistas abdominais, da possibilidade de sintomas gastrointestinais isolados no contexto da COVID-19. Além disso, deve ser um hábito para todos os radiologistas avaliar as bases pulmonares nas tomografias de abdome, local comumente afetado pela COVID-19.

Hernias poco comunes: hernia de Spiegel. Reporte de caso / Uncommon hernias: Spigelian hernia. Case report

La hernia de Spiegel es un defecto infrecuente de la pared abdominal producido por una alteración en la unión del borde lateral del músculo recto del abdomen y el borde medial del músculo transverso del abdomen en la línea semilunar. Representan apenas del 0,12 al 2% de todas las hernias. La presente investigación se enfocó en describir las manifestaciones clínicas, el diagnóstico, la incidencia, el procedimiento quirúrgico y su evolución en dos casos reportados. Caso 1: Femenina de 33 años, multípara, obesa, quien consulta por dolor y masa palpable en el cuadrante superior izquierdo del abdomen. Al examen físico, se evidenció dolor a la palpación en mesogastrio e hipocondrio izquierdo, exhibiendo protrusión del contenido abdominal, en la línea de Spiegel. Intervención quirúrgica: hernioplastia protésica de Spiegel con colocación de malla supraaponeurótica. Caso 2: Masculino de 89 años, con diagnóstico de EPOC, acudió a consulta presentando dolor abdominal en fosa iliaca y en la región inguino­escrotal izquierda. Al examen físico se evidenció saco herniario en la región inguino­escrotal por lo que se decide su resolución quirúrgica. Como hallazgo transoperatorio se evidenció defecto aponeurótico del recto anterior del abdomen izquierdo en su tercio inferior. Intervención quirúrgica: hernioplastia protésica de Spiegel con colocación de malla supraaponeurótica.Conclusión : La hernia de Spiegel es una entidad poco frecuente por lo que se debe concientizar al cirujano para sospechar este tipo de hernia en aquellos pacientes con presencia de aumento de volumen en la línea de Spiegel(AU)

Spigelian hernia is an infrequent abdominal wall defect caused by an alteration in the joint between lateral edge of the rectus abdominis muscle and the medial egde of the transverse abdominis muscle in the semilunar line. It represent only from 0.12 to 2% of all hernias. This investigation is focussed on describe the clinical manifestations, diagnosis, incidence, the surgical procedure and its evolution in two reported cases. Case 1: A 33 years old female, multiparous, obese, who consulted for pain and palpable mass in the left upper quadrant of the abdomen. Physical examination revealed tenderness between mesogastrium and left hypochondrium, showing protrusion of abdominal content, in the Spigelian line. Surgical intervention: Prosthetic Spiegel hernioplasty with supraaponeurotic mesh. Case 2: An 89 years old male, diagnosed with COPD, attended in the consultation presenting abdominal pain in the iliac fossa and in the left inguino-scrotal region. Physical examination revealed hernial sac in the inguino-scrotal region, reason which its surgical resolution is decided. As an intraoperative finding, an aponeurotic defect of the anterior rectus of the left abdomen was evidenced in its lower third. Surgical intervention: Prosthetic Spiegel hernioplasty with supraaponeurotic mesh.Conclusion : Spigelian hernia is a rare entity, so the surgeon must be focused on suspect this kind of hernia in patients with growth in Spiegel line(AU)

Obstrucción intestinal por brida postquirúrgica en gestante: a propósito de un caso / Intestinal obstruction due to postsurgical bridle in pregnant woman: on the subject of a case

RESUMEN El dolor abdominal en gestantes supone un diagnóstico complejo por el múltiple diagnóstico diferencial que existe. Es necesaria la realización de un diagnóstico precoz para reducir el número de complicaciones. Para ello, nos apoyamos no sólo en criterios clínicos si no en pruebas de imagen como la resonanacia magnética nuclear. Nuestro objetivo es la realización de una revisión bibliográfica sobre el dolor abdominal en gestantes, centrándonos en la obstrucción intestinal, a propósito de un caso de una gestante con dolor abdominal agudo a la que se le diagnosticó de isquemia intestinal secundaria a obstrucción intestinal por brida postquirúrgica. La obstrucción intestinal es una causa infrecuente y potencialmente grave de dolor abdominal agudo en gestantes, que cursa con clínica insidiosa y que precisa cirugía como tratamiento.

ABSTRACT Abdominal pain in the pregnant woman is complex to diagnose because of the multiple differential diagnosis that exists. It is necessary to perform an early diagnosis to reduce the number of complications. For this, we rely not only on clinical criteria but on imaging tests such as nuclear magnetic resonance. Our objective is to review the literature on abdominal pain in pregnant women, focusing on intestinal obstruction, and with regard to the case of a pregnant woman with acute abdominal pain who was diagnosed of intestinal ischemia due to intestinal obstruction by post-surgical bridle. Intestinal obstruction is an infrequent and potentially serious cause of acute abdominal pain in the pregnant woman, which is insidious and requires surgery as a treatment.

Rol del ultrasonido en la evaluación del dolor abdominal agudo / The Role of Ultrasound in Assessing Acute Abdominal Pain

RESUMEN Introducción: El ultrasonido es una prueba de imagen segura y efectiva que ha ayudado a los médicos por más de medio siglo en el diagnóstico de enfermedades y se ha convertido en el estetoscopio del siglo XXI. El dolor abdominal agudo es una causa muy frecuente en los departamentos urgencia y emergencias de todo el mundo. Objetivo: Exponer la utilidad del ultrasonido en la evaluación del dolor abdominal agudo. Método: Se realizó una revisión bibliográfica del tema en las bases de datos PubMed, BVS-BIREME y Cochrane. Se consideraron en la búsqueda todo tipo de estudios publicados desde enero de 1958 hasta junio de 2018, a los cuales se tuvo acceso. Los idiomas utilizados en la búsqueda fueron el español y el inglés. Resultados: De forma general, la tomografía axial computarizada es el estudio por imagen de mayor sensibilidad y especificidad en evaluación del dolor abdominal agudo, lo que supera objetivamente al ultrasonido. Sin embargo, la utilización del ultrasonido por médicos no radiólogos, como complemento del examen físico gana cada día más espacio, sobre todo después del surgimiento del Point-of-Care Ultrasonography. Conclusiones: El ultrasonido realizado por radiólogos es una herramienta útil en la evaluación del dolor abdominal agudo. El cirujano general puede diagnosticar con precisión los cálculos biliares pero el diagnóstico de colecistitis y de apendicitis es más desafiador. Son necesarios más estudios para avalar la utilización del ultrasonido por cirujanos generales en la evaluación del dolor abdominal agudo(AU)

ABSTRACT Introduction: Ultrasound is a safe and effective imaging test that has helped physicians for more than half a century in the diagnosis of diseases and has become the stethoscope of the 21st century. Acute abdominal pain is a common cause in urgency departments and emergency rooms worldwide. Objective: To present the usefulness of ultrasound in the assessment of acute abdominal pain, performed in the department of radiology, emergency and by general surgeons. Method: A literature review of the subject was carried out in the databases PubMed, BVS-BIREME and Cochrane. All types of studies published from January 1958 to June 2018, which were accessed, were considered in the search. The languages used in the search were Spanish and English. Results: Generally speaking, the computed tomography is the imaging study of greater sensitivity and specificity in the assessment of acute abdominal pain, objectively surpassing ultrasonography. However, the use of ultrasound by non-radiological physicians, as a complement to the physical examination, gains more space each day, especially after the emergence of point-of-care ultrasonography. Conclusions: Ultrasonography performed by radiologists is a useful tool in the assessment of acute abdominal pain. The general surgeon can accurately diagnose gallstones, but the diagnosis of cholecystitis and appendicitis is more challenging. More studies are needed to support the use of ultrasound by general surgeons in the assessment of acute abdominal pain(AU)

A rare cause of abdominal pain in childhood: cardiac angiosarcoma

Abstract Cardiac angiosarcomas are extremely rare in childhood, they are rapidly progressive tumours that often present themselves as diagnostic dilemmas, resulting in delayed diagnosis. Also, extracardiac manifestations, including abdominal pain, are extremely rare in patients with intracardiac tumors. We herein present the case of a 15-year-old girl who presented with abdominal pain. Echocardiography and thoracic computed tomography showed right atrial mass. The patient underwent surgery, chemotherapy, and radiotherapy. Eight months after treatment, abdominal recurrence was detected. The abdominal mass was resected, and radiotherapy and new chemotherapy protocol were given. The present case illustrates a rare case of primary cardiac angiosarcoma posing a diagnostic dilemma in an adolescent girl.

Reliability of barr, leech, and blethyn score in using of plain radiography in determining fecal impaction in children with and without constipation / Confiabilidade de pontuação dos escores de Barr, Leech e Blethyn no uso de radiografia simples na determinação da impactação fecal em crianças com e sem constipação

ABSTRACT Background - Several scoring was developed for evaluation of children with fecal retention using plain radiograph. There are controversies about specificity and sensitivity of these scoring system. Objectives - The aim of this study was to evaluate Barr, Blethyn, and Leech score in evaluation of fecal load in plain radiograph. Methods - This case control study was conducted on children aged 2-14 years old with abdominal pain who visited Abuzar children's Hospital of Ahvaz University of Medical Sciences. This study was conducted in fall season. Children with history of previous abdominal surgery, any systemic illness including sickle cell anemia were excluded. Children with constipation were placed in case group. Subjects without constipation were placed in control group. Subjects without exclusion criteria were examined by physician who is blind to aim of the study. Careful history and physical examination was done. Demographic features, history of gastrointestinal problem, duration of abdominal pain, defecation habit, stool consistency (loose, hard), and results of physical examination were recorded. Rome III criteria was used for definition of constipation. Abdominal x-ray was ordered for each patients. Abdominal radiography was reviewed by radiologist. Barr, Leach, and Blethyn scores were calculated for each case. Results - In this study 102 children with functional constipation and 102 children without constipation as a control were included. Mean ±SD for case and control group was 68.39±34.88 and 69.46±32.60 (P=0.82).Leech score (mean ±SD) was 11.05±2.177 and 5.67±3.228 for case and control group respectively (P<0.0001). Barr score (mean ±SD) was 14.86±3.54 and 7.16±5.59 for case and control group respectively (P=<0.0001). Blethyn (mean ±SD) score was 1.97±0.667 and 1.04±0.900 for case and control group respectively (P=0.000). Sensitivity and specificity of Barr score was 83% and 79% respectively. Sensitivity and specificity of Leech score was 92% and 80% respectively. Sensitivity and specificity of Blethyn score was 79% and 92% respectively. Conclusion - Barr, Blethyn and Leech scores were significantly higher in children with abdominal pain and constipation in contrast to children with abdominal pain and without constipation. Sensitivity of Leech score was more than Barr and Blethyn scoring systems. Specificity of Blethyn score was more than Barr and Leech score.

RESUMO Contexto - Diversos métodos de pontuação utilizando a radiografia simples foram desenvolvidos para a avaliação de retenção fecal em crianças. Há controvérsias sobre a especificidade e sensibilidade destes sistemas de pontuação. Objetivo - O objetivo deste estudo foi avaliar os sistemas de escore Barr, Blethyn e Leech na avaliação do conteúdo fecal pela radiografia simples. Métodos - Estudo de caso controle em crianças com idade entre 2-14 anos, com dor abdominal que consultaram o Abuzar children's Hospital of Ahvaz University of Medical Sciences, durante o outono. Crianças com história prévia de cirurgia abdominal, com qualquer doença sistêmica, incluindo anemia falciforme, foram excluídas. Crianças com constipação foram inseridas no estudo e crianças sem constipação inseridas no grupo controle. Pacientes sem critérios de exclusão foram examinados por médico que ignorava o objeto do estudo. Foram realizadas história clínica e exame físico cuidadosos. Foram registradas as características demográficas, a história do problema gastrointestinal, a duração da dor abdominal, os hábitos intestinais e evacuatórios, a consistência das fezes (duras, amolecidas), e os resultados do exame físico. Os Critérios de Roma III foram usados para a definição de constipação. Radiografia simples do abdômen foi ordenada para cada paciente. Foram calculados os escores de Baar, Leech e Blethyn para cada paciente. Resultados - Foram incluídas neste estudo 102 crianças com constipação funcional e 102 crianças sem constipação como controle. A idade média com desvio padrão para o grupo paciente foi de 68.39±34.88 e de 69.46±32.60 para o grupo controle (P=0.82). O escore de Leech (média ±DP) foi de 11.05±2.1777 para pacientes e de 5.67±3.228 para o grupo controle (P<0.0001). A pontuação de Barr (média ± DP) foi 14.86±3.54 para pacientes e de 7.16±5.59 para o grupo controle (P=<0.0001). O escore Blethyn (média ±DP) foi de 1.97±0.667 para pacientes e de 1.04±0.900 para o grupo controle (P=0.000). A sensibilidade e especificidade para o escore de Baar foi de 83% e 79% respectivamente. Para o escore de Leech foi de 92% de sensibilidade e 80% de especificidade. O escore de Blethyn resultou em 79% de sensibilidade e especificidade de 92%. Conclusão - As pontuações de Baar, Blethyn e Leech foram significativamente maiores em crianças com dor abdominal e constipação em contraste com as crianças com dor abdominal e sem constipação. A sensibilidade de pontuação Leech foi maior do que os sistemas de pontuação Barr e Blethyn. Escore de Blethyn teve mais especificidade que as pontuações Barr e Leech.

Enfisema masivo subcutáneo posterior a la realización de una colangiopancreatografía retrograda endoscópica con esfinterotomia y síndrome de lemmel / Massive subcutaneus emphysema following endoscopic retrograde cholangiopancreatography with sphincterotomy and lemmel syndrome

La colangiopancreatografia endoscópica es un procedimiento muy frecuente en nuestro medio como parte del diagnóstico y tratamiento de patologías de la vía biliar, sin embargo no es exento de complicaciones algunas de ella pueden considerarse graves. En el presente caso clínico se presenta una paciente femenina de 55 años, a la cual se le realizo una CPRE con Diagnóstico de un síndrome de Lemmel, se le realizo esfinterotomía, a las cuatro horas post procedimiento desarrolla un enfisema subcutáneo masivo además de neumperitoneo y neumotórax, sin datos de peritonismo ni dolor abdominal. Se presenta el caso debido a lo llamativo de la presentación clínica, la resolución rápida solo con manejo conservador. En conclusión al parecer se produce esta complicación post CPRE debido a una microperforación, no existe una perforación evidente duodenal, o biliar, y el divertículo suprapapilar actúa como un sistema de baja presión con efecto valvular produciendo escape de aire hacia planos faciales subcutáneos peritoneales y pleurales debido a la insuflación por el duodenoscopio, el manejo es conservador y de buen pronóstico.

Endoscopic Retrograde Cholangiopancreatography (ERCP), is a very common procedure in our commonly used in the diagnosis and treatment of biliary pathology, though not without complications, some of them can be considered serious. In this case report a female patient of 55 years old is presented, which is performed ERCP with Syndrome diagnosis Lemmel, with sphincterotomy, at four hours post procedure developed massive subcutaneous emphysema besides pneumoperitoneum and pneumothorax, no data of peritonitis or abdominal pain, clinical case due to the striking of the clinical presentation and rapid resolution with conservative management alone is presented. In conclusion apparently this post ERCP complication due to Microperforation occurs, there is no apparent biliary or duodenal perforation, and supra papillary diverticulum acts as a low pressure system with valve effect causing air leakage into subcutaneous fascial planes, and peritoneal and pleural due insufflation with duodenoscope, management is conservative and good prognosis.

Evaluating the Accuracy of Emergency Medicine Resident Interpretations of Abdominal CTs in Patients with Non-Traumatic Abdominal Pain

Abdominal computed tomography (CT) is widely used as a diagnostic tool in emergency medicine (EM) to accurately diagnose abdominal pain. EM residents must be able to offer preliminary interpretations of CT imaging. In this study, we evaluated the preliminary interpretation ability of a sample of emergency residents presented with adult abdominal CT images, and compared their results with those of radiology residents. We conducted a prospective observational study from November 16, 2008 to June 30, 2009. During this time, we gathered preliminary interpretations of consecutive abdominal CT made by emergency and radiology residents. We assessed the discrepancy rates of both samples by comparing their findings to the final reports from attending radiologists. A total of 884 cases were enrolled in the present study. The discrepancy rates of emergency and radiology residents were 16.7% and 12.2%, respectively. When female genital organs, peritoneum, adrenal glands, or the musculoskeletal system were abnormal, we found that emergency residents' preliminary interpretations of CT images were insufficient compared to those of radiology residents. Therefore more formal education is needed to emergency residents. If possible, the preliminary interpretations of radiology attending physicians are ideal until improving the ability of interpretations of emergency residents in abdomen CT.

A Case of Gallstone Ileus Treated with Electrohydraulic Lithotripsy Guided by Colonoscopy / 대한소화기학회지

A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstructive bowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient's known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals.

Plain abdominal radiographs and acute abdominal pain

In this study we audited one district general hospital's current practice of performing abdominal X-ray [AXR] in adult patients with acute abdominal pain. Data was collected from patients' notes one day post-admission and a total of 100 consecutive cases were reviewed in a two month period. AXR were deemed unnecessary in 53% of these in view of the patients' clinical presentation. Inappropriate use of AXR is a source of preventable radiation, patient discomfort and also an aspect of financial burden on the NHS. By educating staff, introducing an A and E poster and departmental protocol, the use of AXR can be restricted to necessary cases only

Diagnostic evaluation of [pregnant] patient with acute abdominal pain. The role of imaging modalities

Assess the pregnant patient with other causes of pain not related to pregnancy presenting to emergency department, using different imaging modalities and to review the basic principles of radiation safety. During 18 months, 55 pregnant patients were referred randomly from emergency department for evaluation of abdominal pain prospectively enrolled into our study. Pregnant with pregnancy-related causes such as premature contractions and other related causes were excluded. US evaluation for all patients including a careful search for gall bladder, kidneys, pancreas and appendix related causes. Clinical, surgical, and/or imaging follow-up data were obtained in some patients. Out of 55 patients, 28[50.90%] were confirmed to have an eight with gall-bladder stones [14.54%] five with hydronephrosis related to pregnancy [9.08%], two of renal calculi [3.63%] one had bowel obstruction and pancreatitis [1.81%],seven with pyelonephritis[12.72%], and four with appendicitis [7.27%]. There is an increased incidence of acute abdomen during pregnancy though clinical pictures sometimes get blunted due to gravid uterus. Early diagnosis followed by surgical intervention if needed decrease morbidity for both mother and fetus, also enhances our knowledge of the principles of radiation safety

Evaluation of the necessity of the three-film abdominal series in the diagnosis of abdominal pain.

The routine plain-film abdominal series, consisting of supine and upright abdominal radiographs and upright chest radiograph of 246 patients, who presented with abdominal pain from the emergency room of Bangkok Metropolitan Administration Medical College and Vajira Hospital from January 2000 to May 2001 were reviewed. Each radiograph was independently interpreted to detect any radiographic abnormality. Radiographic abnormalities were detected in 35 per cent on abdominal films and 13 per cent on chest films. The supine abdominal views could diagnose abnormalities in 84 per cent of these patients while the upright views diagnosed abnormalities in only 16 per cent of these cases. Most of the detectable abnormalities in the upright views were pneumoperitoneums that were clearly demonstrated on the upright chest radiographs. So elimination of the upright abdominal view from the routine plain-film abdominal series in the screening of surgical cases from medical cases could result in cost-saving and a decrease in radiation exposure without significant loss of diagnostic information.