Shilpa Jain, S (2020) High Density Free Fluid in Acute Abdomen on Computed Tomography: A Predictor of Intervention. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Patients with acute abdomen often develop intraabdominal free fluid (IFF). While IFF is a finding on abdominopelvic computed tomography (CT) associated with the need for surgical intervention, many patients with IFF can be still managed non-operatively. A previous study suggested that a higher red blood cell count of IFF is highly predictive of intervention. We hypothesized that radiodensity in IFF (Hounsfield unit (HU)) on CT would predict the need for surgical intervention. AIM & OBJECTIVE: 1. To compare the computed tomography attenuation values of free fluid abdomen in patients those on conservative management vs intervention done. 2. To evaluate the computed tomography (CT) attenuation values of ascites to predict post op infection risk, need for prolonged hospitalization and outcome. METHODOLOGY: Patients Who Fit The Inclusion Criterion Will Be Studied And The Various Factors Analysed. SUBJECT SELECTION: Patients Admitted With Acute Abdominal Pain And CT Abdomen done. SAMPLE SIZE: 100. INCLUSION CRITERIA: 1.Patient admitted for pain abdomen for whom computed tomography was done. 2.Patients of age groups 13 years and above 3.Patients with free fluid in CT abdomen and pelvis above 30 ml. EXCLUSION CRITERIA: 1. Cases with medical cause of ascites 2. Age less than 13 years. 3. Cases operated on the abdomen less than 6 weeks back. RESULTS: In cases of perforation the HU of the free fluid was higher for perforations of large bowel compared to small bowel perforation. In the post operative period patients who had wound site infection and prolonged hospital stay had a relatively higher HU value on CT. A cut off value of 16.1 was obtained for the HU in this study ie cases with above 16.1 HU had likely possibility of requiring an operative intervention. The sensitivity of this study was 80.77. The specificity of the study was 79.73. The positive predictive value was 58.33. The negative predictive value was 92.19. The accuracy was 80.25. The p value of this study was 0.0005 which was highly significant. CONCLUSION: Acute abdominal pain can represent a spectrum of conditions from benign and self-limited disease that can be managed conservatively to surgical emergencies. Patients may present clinically in an obvious or subtle manner. Diagnosing a patient with a full-blown acute abdomen is relatively easy but it is difficult to diagnose an incipient abdominal catastrophe in a patient presenting with early, non-specific symptoms. Based on the results of ROC analysis, a cutoff value of 16.1 HU for intra abdominal free fluid was determined to be optimal for predicting the need for surgical intervention. The patients with IFF HU >16.1 were more likely to require surgical intervention than those with a lower density IFF. With the cutoff value of >16,1 HU, the sensitivity, specificity, PPV, NPV, and accuracy to predict the need for surgical intervention were 80.77, 79.73, 58.33, 92.19 and 80.25% respectively in this study. HU helps in predicting the site of perforation . Higher HU values were seen in distal perforations . It also helps us to keep in mind the possibility of increased post operative complications . In patients presenting with acute abdomen history of presenting illness, clinical findings and radiological findings along with the additional data regarding the radiodensity of IFF analyzed on CT ,would be practical and useful in identifying the need for early surgical intervention.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711017 |
| Uncontrolled Keywords: | High Density Free Fluid, Acute Abdomen, Computed Tomography, Predictor, Intervention. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 09 Feb 2021 00:41 |
| Last Modified: | 09 Feb 2021 00:41 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13934 |
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