Modern imaging technologies in the diagnosis of primary intra-abdominal complications in patients | Український Медичний Часопис

Purpose: to improve the results of treatment of patients with primary intra-abdominal complications through the introduction of the latest informative imaging methods.

Research methods: 191 patients with primary intra-abdominal infiltrates, abscesses and fluid formations were treated in the clinic of the Department of Surgical Diseases № 1, on the basis of the Surgery Center of Kyiv City Clinical Hospital № 1 from 2006 to 2019. The age of patients ranged from 16 to 85 years. Patients were divided into two groups: control group (2006–2012) 0151 102 (53.4%), and the study group (2013–2019) — 89 (46.6%) patients. Examination methods: radiography, ultrasound, computed tomography.

Results. The causes of primary intra-abdominal complications were: complicated forms of appendicitis in 74 (38.7%), perforated gastric and duodenal ulcer in 48 (25.1%), complicated forms of cholecystitis in 69 (36.1%). In the control group, an overview regeneration of the abdominal and thoracic cavity was performed with the clinic of perforated gastric and duodenal ulcer, as well as in patients with suspected intestinal obstruction on the background of an inflammatory process. Analysis of the data of 26 patients showed that in 6 patients there was no free air in the abdominal cavity. In the study group of patients, the cutaneous temperature of the anterior abdominal wall was measured in 48 patients, of whom in 39 patients it was increased by 2–3° C. According to the ultrasound of the abdominal cavity, direct and indirect signs of the inflammatory process were established. Ultrasound was performed in 81 of 89 patients, of which with destructive appendicitis in 35, destructive cholecystitis in 32 and with perforated gastric and duodenal ulcer in 14 patients. The visualization was established in 68 patients with destructive appendicitis, of which appendicular abscess in 15 and appendicular infiltration in 18 patients. Localization of the appendix according to ultrasound data: typical — in 22, medial — in 6 and subhepatic — in 7 patients. Ultrasound of the gallbladder was performed in 32 patients, and established changes indicated an inflammatory process. Radiography was performed in 22 patients with perforated gastric and duodenal ulcer, of which free air was found in 17 patients. Computed tomography was performed in 16 patients.

Conclusions. In order to verify acute intra-abdominal pathology, skin thermometry was informative in 39 of 48 patients. When verifying a perforated gastric and duodenal ulcer in 17 of 22 patients, radiography was not informative, which required computed tomography. The study of the abdominal cavity using ultrasound was informative from 48.1% to 73.5% depending on the pathology (destructive appendicitis, destructive cholecystitis) and the development of complications with sensitivity from 58 to 84.5% and specificity from 69 to 89.3%. Such discrepancies are associated with the constant improvement of the survey methodology.

References:

1. Ministry of Health of Ukraine (2016) Unified clinical protocol of emergency, primary and secondary (specialized) medical care. Acute appendicitis. Kyiv, 75 p. (In Ukr.).
2. Fomin P.D., Usenko O.Yu., Bereznytsky Ya.S. (Eds.) (2018) Emergency abdominal surgery (standards of organization and professionally oriented algorithms of medical care). Library «Health of Ukraine», Kyiv, 354 p. (In Ukr.).
3. Di Saverio S., Podda M., De Simone B. et al. (2020) Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J. Emerg. Surg., 27(2020). https://doi.org/10.1186/s13017-020-00306-3
4. Duke E., Kalb B., Arif-Tiwari H. et al. (2016) A systematic review and meta-analysis of diagnostic performance of MRI for evaluation of acute appendicitis. Am. J. Roentgenol., 206: 508–517.
5. Pisano M., Allievi N., Gurusamy K. et al. (2020) 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis (https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00336-x).
6. Huffman J.L., Schenker S. (2010) Acute acalculous cholecystitis: a review. Clin. Gastroenterol. Hepatol., 8(1): 15–22. doi:10.1016/j.cgh.2009.08.034
7. Tarasconi A., Coccolini F., Biffl W.L. et al. (2020) Perforated and bleeding peptic ulcer: WSES guidelines. World J. Emerg. Surg. https://doi.org/10.1186/s13017-019-0283-9
8. Chung K.T., Shelat V.G. (2017) Perforated peptic ulcer — an update. World J. Gastrointest. Surg., 9(1): 1–12. doi: 10.4240/wjgs.v9.i1.1
9. Stoker J., van Randen A., Laméris W., Boermeester M.A. (2009) Imaging patients with acute abdominal pain. Radiology, 253(1): 31–46. doi: 10.1148/radiol.2531090302
10. Li P.H., Tee Y.S., Fu C.Y. et al. (2018) The Role of Noncontrast CT in the Evaluation of Surgical Abdomen Patients. Am. Surg., 84(6): 1015–1021.
11. Ribalchenko V.F., Demidenko Yu.G. (2020) The method of measuring the temperature of the anterior abdominal wall. Ukrainian patent for a utility model. UA 139580 U МPК (2019.01) A61B 17/00. (In Ukr.).
12. Ribalchenko V.F., Demidenko Yu.G. (2020) Method for diagnosing purulent-septic diseases of abdominal organs by measuring axillary-abdominal coefficient. Ukrainian patent for a utility model. UA 142612 U МPК (2020.01) A61B 17/00 G01N 25/20. (In Ukr.).
13. Ribalchenko V.F., Demidenko Yu.G. (2019) Thermometric panel of the anterior abdominal wall and prognostic axillary-abdominal coefficient. Neonatol. Surg. Perinat. Med., 3(33): 86–94. Doi: 10.24061/2413-4260.IX.3.33.2019.5 (In Ukr.).
14. Ribalchenko V.F., Demidenko Yu.G., Yarmak S.Ya. (2018) Thermometric panel of the anterior abdominal wall in children with infiltrates, abscesses of appendicular origin and prognostic axillary-abdominal coefficient. Surg. Pediatr., 2(59): 96. (In Ukr.).
15. Chang S.T., Jeffrey R.B., Olcott E.W. (2014) Three-step sequential positioning algorithm during sonographic evaluation for appendicitis increases appendiceal visualization rate and reduces CT use. Am. J. Roentgenol., 203: 1006–1012.
16. Fields J.M., Davis J., Alsup C. et al. (2017) Accuracy of point-of-care ultrasonography for diagnosing acute appendicitis: a systematic review and meta-analysis. Acad. Emerg. Med., 24: 1124–1136.
17. Sola R., Theut S.B., Sinclair K.A. et al. (2018) Standardized reporting of appendicitis-related findings improves reliability of ultrasound in diagnosing appendicitis in children. J. Pediatric. Surg., 53: 984–987.
18. Segev L., Segev Y., Rayman S. et al. (2016) The diagnostic performance of ultrasound for acute appendicitis in pregnant and young nonpregnant women: a case-control study. Int. J. Surg., 34: 81–85.
19. Rud B., Olafsson L., Vejborg T.S. et al. (2019) Diagnostic accuracy of computed tomography for appendicitis in adults. Cochrane Database Syst. Rev. https://doi.org/10.1002/14651858.CD009977
20. Anbalakan K., Chua D., Pandya G.J., Shelat V.G. (2015) Five year experience in management of perforated peptic ulcer and validation of common mortality risk prediction models — are existing models sufficient? A retrospective cohort study. Int. J. Surg., 14: 38–44.
21. Kim H.C., Yang D.M., Kim S.W., Park S.J. (2014) Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time. Eur. Radiol., 24: 1386–1393.
22. Ra J.C., Lee E.S., Park H.J. et al. (2018) Efficacy of Superb Microvascular Imaging for Diagnosing Acute Cholecystitis: Comparison with Conventional Ultrasonography. Ultrasound Med. Biol., 44(9): 1968–1977.
23. Martellotto S., Dohan A., Pocard M. (2020) Evaluation of the CT Scan as the First Examination for the Diagnosis and Therapeutic Strategy for Acute Cholecystitis. World J. Surg., 44: 1779–1789. https://doi.org/10.1007/s00268-020-05404-6
24. Urban B.A., Fishman E.K. (2020) Targeted helical CT of the acute abdomen: appendicitis, diverticulitis, and small bowel obstruction. Semin. Ultrasound CT MR, 21(1): 20–39. doi: 10.1016/s0887-2171(00)90011-8
25. Payor A., Jois P., Wilson J. et al. (2015) Efficacy of Noncontrast Computed Tomography of the Abdomen and Pelvis for Evaluating Nontraumatic Acute Abdominal Pain in the Emergency Department. J. Emerg. Med., 49(6): 886–892. doi: 10.1016/j.jemermed.2015.06.062
26. Skiba V.V., Rybalchenko V.F., Ivanko O.V. et al. (2017) Surgical treatment of inflammatory and adhesive processes of the abdominal cavity in adolescents using a jet hydro scalpel. Child Health, 12(1): 68–74. (In Ukr.).
27. Skiba V.V., Rybalchenko V.F., Ivanko O.V. et al. (2017) Surgical treatment of abdominal infiltrates in adolescents using a hydro jet scalpel. Pediatr. Surg., 1: 32–38. (In Rus.).