Advertisement

Diagnostic Tools in ACS: CT Scan, Diagnostic Laparoscopy, and Exploratory Laparotomy

  • Ning Lu
  • Walter L. BifflEmail author
Chapter
First Online:
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)

Abstract

The abdomen is a black box of diagnostic uncertainty. There is an old surgical adage that goes “never let the skin come between you and the diagnosis.” However, it is just that: an old adage. The surgeon has many alternatives to employ in situations in which the clinical diagnoses, or decision to operate, are not straightforward. In this chapter, three primary modalities are discussed: computed tomography (CT) scanning, diagnostic laparoscopy (DL), and exploratory laparotomy (LAP).

This is a preview of subscription content, log in to check access.

References

  1. 1.
    Lee D, Park MH, Shin BS, Jeon GS. Multidetector CT diagnosis of non-traumatic gastroduodenal perforation. J Med Imaging Radiat Oncol. 2015;60(2):182–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Grassi R, Romagno S, Pinto A, Romano L. Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol. 2004;50(1):30–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Fidler J, Paulson EK. Layfield l. CT evaluation of acute cholecystitis: findings and usefulness in diagnosis. AJR Am J Roentgenol. 1996;166(5):1085.CrossRefPubMedGoogle Scholar
  4. 4.
    Paulson EK. Acute cholecystitis: CT findings. Semin Ultrasound CT MR. 2000;21(1):56.CrossRefPubMedGoogle Scholar
  5. 5.
    Bennett GL, Balthazar EJ. Ultrasound and CT evaluation of emergent gallbladder pathology. Radiol Clin North Am. 2003;41(6):1203–16.CrossRefPubMedGoogle Scholar
  6. 6.
    Yarmish GM, Smith MP, Rosen MP, Baker ME, Blake MA, Cash BD, Hindman NM, Kamel IR, Kaur H, Nelson RC, Piorkowski RJ, Qayyum A, Tulchinsky M. ACR appropriateness criteria right upper quadrant pain. J Am Coll Radiol. 2014;11(3):316–22.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Tseng CW, Chen CC, Chen TS, Chang FY, Lin HC, Lee SD. Can computed tomography with coronal reconstruction improve the diagnosis of choledocholithiasis? J Gastroenterol Hepatol. 2008;23(10):1586.CrossRefPubMedGoogle Scholar
  8. 8.
    Singh A, Mann HS, Thukral CL, Singh NR. Diagnostic accuracy of MRCP as compared to Ultrasound/CT in patients with obstructive jaundice. J Clin Diagn Res. 2014;8(3):103–7.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174(2):331–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Clavien PA, Hauser H, Meyer P, Rohner A. Value of contrast-enhanced computerized tomography in the early diagnosis and prognosis of acute pancreatitis. A prospective study of 202 patients. Am J Surg. 1988;155(3):457–66.CrossRefPubMedGoogle Scholar
  11. 11.
    Block S, Maier W, Bittner R, et al. Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging. Gut. 1986;27(9):1035–42.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 2012;262(3):751–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Zalcman M, Sy M, Donckier V, Closset J, Gansbeke DV. Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction. AJR Am J Roentgenol. 2000;175(6):1601–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Mallo RD, Salem L, Lalani T, Flum DR. Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review. J Gastrointest Surg. 2005;9(5):690–4.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Di S, S CF, Galati M, Smerieri N, Biffl WL, Ansaloni L, Tugnoli G, Velmahos GC, Sartelli M, Bendinelli C, Fraga GP, Kelly MD, Moore FA, Mandalà V, Mandalà S, Masetti M, Jovine E, Pinna AD, Peitzman AB, Leppaniemi A, Sugarbaker PH, Goor HV, Moore EE, Jeekel J, Catena F. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the World Society of Emergency Surgery ASBO Working Group. World J Emerg Surg. 2013;8(1):42.CrossRefGoogle Scholar
  17. 17.
    Oliva IB, Davarpanah AH, Rybicki FJ, Desjardins B, Flamm SD, Francois CJ, Gerhard-Herman MD, Kalva SP, Ashraf Mansour M, Mohler ER 3rd, Schenker MP, Weiss C, Dill KE. ACR Appropriateness Criteria® imaging of mesenteric ischemia. Abdom Imaging. 2013;38(4):714–9.CrossRefPubMedGoogle Scholar
  18. 18.
    R W, Nishimaki H, Fujii K, Kakita S, Hayakawa K. Usefulness of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI): assessment of morphology and diameter of the superior mesenteric artery (SMA) on multi-planar reconstructed (MPR) images. Eur J Radiol. 2010;76(1):96–102.CrossRefGoogle Scholar
  19. 19.
    Garst GC, Moore EE, Banerjee MN, Leopold DK, Burlew CC, Bensard DD, Biffl WL, Barnett CC, Johnson JL, Sauaia A. Acute appendicitis: a disease severity score for the acute care surgeon. J Trauma Acute Care Surg. 2013;74(1):32–6.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Smith MP, Katz DS, Lalani T, Carucci LR, Cash BD, Kim DH, Piorkowski RJ, Small WC, Spottswood SE, Tulchinsky M, Yaghmai V, Yee J, Rosen MP. ACR Appropriateness Criteria® right lower quadrant pain—suspected appendicitis. Ultrasound Q. 2015;31:85–91.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Laméris W, van Randen A, Bipat S, Bossuyt PM, Boermeester MA, Stoker J. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008;18(11):2498–511.CrossRefPubMedGoogle Scholar
  22. 22.
    Balfe DM, Levine MS, Ralls PW, Bree RL, DJ DS, Glick SN, Megibow AJ, Saini S, Shuman WP, Greene FL, Laine LA, Lillemoe K. Evaluation of left lower quadrant pain. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000;215 Suppl:167–71.PubMedGoogle Scholar
  23. 23.
    Doria AS, Moineddin R, Kellenberger CJ, et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology. 2006;241:83–94.CrossRefPubMedGoogle Scholar
  24. 24.
    Barger RL Jr, Nandalur KR. Diagnostic performance of magnetic resonance imaging in the detection of appendicitis in adults: a meta-analysis. Acad Radiol. 2010;17(10):1211–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Gaitán HG, Reveiz L, Farquhar C, Elias VM. Laparoscopy for the management of acute lower abdominal pain in women of childbearing age. Cochrane Database Syst Rev. 2014;5:CD007683.Google Scholar
  26. 26.
    Schietroma M, Cappelli S, Carlei F, Pescosolido A, Lygidakis NJ, Amicucci G. "Acute abdomen": early laparoscopy or active laparotomic-laparoscopic observation? Hepatogastroenterology. 2007;54(76):1137–41.PubMedGoogle Scholar
  27. 27.
    Ates M, Coban S, Sevil S, Terzi A. The efficacy of laparoscopic surgery in patients with peritonitis. Surg Laparosc Endosc Percutan Tech. 2008;18(5):453–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Karamanakos SN, Sdralis E, Panagiotopoulos S, Kehagias I. Laparoscopy in the emergency setting: a retrospective review of 540 patients with acute abdominal pain. Surg Laparosc Endosc Percutan Tech. 2010;20(2):119–24.CrossRefPubMedGoogle Scholar
  29. 29.
    Golash V, Willson PD. Early laparoscopy as a routine procedure in the management of acute abdominal pain: a review of 1,320 patients. Surg Endosc. 2005;19(7):882–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Kirshtein B, Roy-Shapira A, Lantsberg L, Mandel S, Avinoach E, Mizrahi S. The use of laparoscopy in abdominal emergencies. Surg Endosc. 2003;17(7):1118–24.CrossRefPubMedGoogle Scholar
  31. 31.
    Coccolini F, Tranà C, Sartelli M, Catena F, Di Saverio S, Manfredi R, Montori G, Ceresoli M, Falcone C, Ansaloni L. Laparoscopic management of intra-abdominal infections: systematic review of the literature. World J Gastrointest Surg. 2015;7(8):160–9.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Coccolini F, Ansaloni L, Manfredi R, Campanati L, Poiasina E, Bertoli P, Capponi MG, Sartelli M, Di Saverio S, Cucchi M, Lazzareschi D, Pisano M, Catena F. Peritoneal adhesion index (PAI): proposal of a score for the "ignored iceberg" of medicine and surgery. World J Emerg Surg. 2013;8(1):6.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Kirshtein B, Roy-Shapira A, Lantsberg L, Avinoach E, Mizrahi S. Laparoscopic management of acute small bowel obstruction. Surg Endosc. 2005;19(4):464–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Babu BI, Siriwardena AK. Current status of minimally invasive necrosectomy for post-inflammatory pancreatic necrosis. HPB (Oxford). 2009;11(2):96–102.CrossRefGoogle Scholar
  35. 35.
    Butcher P, Pugin F, Morel P. Minimally invasive necrosectomy for infected necrotizing pancreatitis. Pancreas. 2008;36(2):113–9.CrossRefGoogle Scholar
  36. 36.
    Hori Y, SAGES Guidelines Committee. Diagnostic laparoscopy guidelines: This guideline was prepared by the SAGES Guidelines Committee and reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), November 2007. Surg Endosc. 2008;22(5):1353–83.CrossRefPubMedGoogle Scholar
  37. 37.
    Pearl J, Price R, Richardson W, Fanelli R, Society of American Gastrointestinal Endoscopic Surgeons. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc. 2011;25(11):3479–92.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hawaii Residency Program in General SurgeryHonoluluUSA
  2. 2.Acute Care SurgeryThe Queen’s Medical CenterHonoluluUSA
  3. 3.Department of Surgery, John A. Burns School of MedicineUniversity of Hawaii—ManoaHonoluluUSA

Personalised recommendations

Cite chapter