| Abstract: |
SUMMARY AND CONCLUSIONAcute abdominal pain is one of the most common surgical condition which calls for prompt diagnosis and treatment. Diagnostic error on the initial assessment may lead to unnecessary surgical intervention, and at most to death of the patient, or a protracted clinical illness due to development of complications which could be avoided by earlier surgical intervention.The study was carried out on 897 cases during a retrospective period from 1/1/2003 to 30/12/2003 and 1196 cases during a prospective period from 1/1/2004 to 1/1/2005 admitted to contingencies Hospital of Zagazig University.The age ranged from 3-80 years with a mean age of (38) years. 1085 cases were females (51.8%) and 1008 cases were males (48.2%).The aetiology of acute abdomen was as fallow:Acute appendicitis, intestinal obstruction, peritonitis, acute cholycystitis, gyneacological, causes and unsettled diagnosis (query appendicitis).In this study the clinical examination, laboratory and radiological investigations helped in the evaluation of management and outcome of the patients with acute abdomen.The study revealed that, the clinical picture and total leukocytic count have an important role in the diagnosis of acute appendicitis.Regarding the outcome of acute appendicitis: 1145 patients (91.6%) underwent appendectomy with uneventful recovery. Fifty-six cases (4.4%) developed postoperative wound sepsis. Twenty cases (1.7%) developed postoperative paralytic ileus. Twenty-eight cases (2.2%) developed chest infection.The study revealed that, the clinical picture, serum electrolytes and plain x-ray have an important role in the diagnosis of intestinal obstruction.Regarding the outcome of acute intestinal obstruction: 78 cases of adhesive obstruction improved by medical treatment and 313 cases were treated surgically.The study revealed that, the clinical picture, total leukocytic count, plain x-ray, and abdominal sonograhpy have an important role in the diagnosis of peritonitis.Regarding the outcome of peritonitis: 46 cases of 1ry peritonitis were treated conservatively, 184cases of 2ry peritonitis were treated surgically. Twenty-seven cases (11.8%) of them developed wound sepsis, nine cases (4%) developed chest infection and nine cases (4%) developed postoperative paralytic ileus.The study revealed that, the clinical picture, total leukocytic count and abdominal sonography were helpful in cases of acute cholecystitis.Regarding the outcome of acute cholecystitis: Fifty Cases of them improved by conservative management ten cases underwent surgery. Two Cases underwent ERCP.The study proved also that, the clinical picture, and abdominal sonography are useful in diagnosis of gynecological causes of acute abdomen.Regarding the outcome of gynecological causes of acute abdomen was as follows: the nineteen cases were treated surgically and three cases of them developed postoperative paralytic ileus.The study revealed that, the clinical picture, abdominal sonography, C.T., T.L.C and serum amylase were very important in diagnosis of acute pancreatitis.Regarding the outcome of acute pancreatitis: 15cases were treated medically, two cases were explored due to unsettled diagnosis and six cases died due to different causes (shock, organ failure, respiratory distress and postoperative complications).The study revealed that, the clinical picture, abdominal sonography and C.T. were very important in diagnosis of abdominal aortic aneurysm.Regarding the outcome of abdominal aortic aneurysm: one case of rupture aortic aneurysm was treated in our unit by endovascular stent and the other three cases were sent to another hospital .Regarding this study, in acute abdomen a careful, methodic and diagnostic approach is necessary in order to arrive at a correct diagnosis. Rapid or quick decision are usually not required and are often incorrect or misleading .If the information of history, physical examination, laboratory data, and radiography studies is not conclusive, then periodic re-examination of the patient with appropriate laboratory data and repeated radiological examination often resolve what earlier appeared to be an uncertain diagnosis.
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