Fig. Classificationofthe9patientsinacuteabdomen Fig.2 DiagnosisandtherapyforthepatientswithoutemergencyCT
Fig.3 Diagnosisandtherapyforthepatientswithacuteappendicitisandotherdiseasesnecessitatingdiferentialdi agnosis
Table DiagnosisandtherapyforthepatientswithbowelobstructionwhounderwentemergencyCT Treatment Conservative therapy Operation Numberofpatients Finaldiagnosis Numberof patients Admissiondiagnosis Paliative Urgent Emergency Simpleintestinalobstruction 25 Simpleintestinalobstruction 25 2 5 8 Adhesivebowelobstruction 6 Adhesivebowelobstruction 6 5 Colorectalcancer 5 Colorectalcancer 5 2 3 Superiormesentericarterysyndrome Superiormesentericarterysyndrome Unknown 3 Impactionofbezoar Unknown 2 2 Strangulationobstruction 4 Strangulationobstruction 4 Internalhernia(paraduodenalhernia) Internalhernia(paraduodenalhernia) Externalhernia Externalhernia Umbilicalhernia Umbilicalhernia Femoralhernia Femoralhernia Obturatorhernia Obturatorhernia 29 29 4 2 5 8
Table2 Diagnosisandtherapyforthepatientswithperfarationofdigestivetract Age/ Gender Admissiondiagnosis Freeair X-ray CT Therapy Finaldiagnosis 56/M 73/M 75/M 48/F PerforationofupperGItract PerforationofupperGItract Stercoralperforationoftherectum Perforationofdigestivetractwithunknownorigin Perforationoftheduodenalulcer Perforationoftheearlygastriccancer Stercoralperforationoftherectum Stercoralperforationofthesigmoidcolon Table3 PatientswhocouldnotdiagnoseaccuratelyonadmissionbyexaminationincludingCT Admissiondiagnosis Finaldiagnosis Posibilityof diagnosis Bowelobstruction 84/F Bowelobstructionwithunknownorigin Impactionofbezoar Acuteappendicitisandotherdiseasesnecessitatingdiferentialdiagnosis 5/F Pericecalabscess Acuteperforatedappendicitiswithabscess 57/M Pericecalabscess Colonicdiverticulitiswithabscess 39/M Pericecalabscess Colonicdiverticulitiswithabscess 22/M Gastroenteritis Acuteappendicitis Perforationofthedigestivetract 48/F Perforationofthedigestivetract,withunknownorigin Stercoralperforationofthesigmoidcolon Possible Impossible Possible Possible Possible Impossible Table4 Statisticalanalysisofadmissiondiagnosis inpatientswithacuteabdominalpainwhounderwentemergencyct Classificationofthepatients withacuteabdominalpain Bowelobstruction Acute appendicitis and otherdiseasesnecessitating diferentialdiagnosis Perforation ofthedigestive tract Otherdiseases Number of Sensitivity Specificity Accuracy patients 29 36 4 70 96.3 88.6 75.0 00 9.0 00 00 00 96.5 88.9 75.0 00 9.4 µ µ
Table5 Physicalandlaboratoryfindingsofthepatientswithbowelobstruction No.of patients Muscular guardingor reboundten derness WBC (/μl) CRP (mg/dl) LDH (IU/L) CPK (IU/L) K (meq/l) BUN (mg/dl) Simpleintesti nalobstruction 25 (4.0%) 9,052±3,660 2.0±4.2 208±52 35±22 4.2±0.6 25.±.9 Emergency Strangulation CT(+) obstruction 4 (25.0%) 8,525±5,24 6.6±.0 33±29 202±20 4.±0.3 26.3±2.4 29 2(7.0%) 8,979±3,802 2.5±5.2 225±78 44±2 4.2±0.6 25.3±.7 Simpleintesti nalobstruction 7 0(0%) 9,306±2,783.3±2. 256±208 98.4±60.5 3.9±0.6 22.4±20. Emergency Strangulation CT(-) obstruction 4 0(0%) 8,00±4,26 0.2±0. 239±54 95.7±8.9 3.8±0.4 2.4±2. Overal Simpleintesti nalobstruction Strangulation obstruction 2 42 8 50 0(0%) (2.4%) (2.5%) 2(4.0%) 9,076±2,997 9,55±3,298 8,33±4,354 9,020±3,454.±.9.7±3.5 3.4±7.8 2.0±4.2 254±97 228±39 300±4 237±37 98.0±55.9 20±0 56±03 25±0 3.9±0.5 4.±0.6 4.0±0.4 4.±0.6 2.0±8.8 24.0±5.7 20.4±.4 23.5±5. Table6 Physicalandlaboratoryfindingsofthepa tientswithacuteappendicitisorotherdiseasesne cessitationgdiferentialdiagnosis Table7 PatientswithbowelobstructionthatemergencyCT wasefectivefordiagnosisanddecision oftherapy Surgery(+) Acuteap Surgery(-) pendicitis Other diseases Overal Surgery(+) Surgery(-) Surgery(+) Surgery(-) No.of patients 6 9 25 2 9 8 8 36 Muscular guardingor reboundten derness 4(87.5%) 4(44.4%) 8(72.0%) 2(00%) CRP WBC(/μl) (mg/dl) 5,39±4,542 *,333±2,286 3,884±4,295 4,400±2,05 4(44.4%) 4,300±6,600 6(54.5%),73±2,574 6(88.9%) 8(44.4%) 24(66.7%) 5,056±4,363 *,056±2,395 3,056±4,08 5.5±7.2 4.3±4. 5.±6.2 4.5±7.6 6.2±8.2 6.8±7.7 7.0±7.9 4.3±4. 5.6±6.6 * p< 0.05 Age/ Gender Diagnosis Simpleintestinalobstruction. 6/F 2. 87/F 3. 87/M 4. 54/M 5. 65/M 6. 8/M Cecalcancer Ascendingcoloncancer Transversecoloncancer Sigmoidcoloncancer Rectalcancer Superiormesentericartery syndrome Strangulationobstruction. 82/F 2. 24/M Obturatorhernia Paraduodenalhernia Therapy Paliativeoperation Paliativeoperation Paliativeoperation Urgentoperation Urgentoperation Conservativetherapy