Acute abdomen

Abstract: SECTION I: SURGICAL BASIC PRINCIPLES History of Surgery Molecular and Cell Biology The Role of Cytokines as Mediators of the Inflammatory Response Fluid, Electrolytes & Shock Hematologic Principles in Surgery Metabolism in Surgical Patients Wound Healing Critical Assessments of Outcomes SECTION II: PERIOPERATIVE MANAGEMENT Principles of PreopPreparation Principles of OperTechnique Surgical Infections & Choice of Antibiotics Surgical Problems in the Immunosuppressed Patient Surgical Complications Surgery in the Elderly The Surgical Treatment of Morbid Obesity Anesthesiology Principles Pain Management and Conscious Sedation Minimally Invasive Surgery SECTION III: TRAUMA & CRITICAL CARE Management of Acute Trauma Burns Bites and Stings Critical Care Respiratory Failure SECTION IV: TRANSPLANTATION AND IMMUNOLOGY Transplantation, Immunobiology & Immunosuppression Transplantation of Abdominal Organs SECTION V: SURGICAL ONCOLOGY Tumor Biology and Tumor Markers Melanoma and Cutaneous Malignancies Soft Tissue Sarcomas & Bone Tumors SECTION VI: HEAD AND NECK Head and Neck SECTION VII: BREAST Breast Breast Reconstruction SECTION VIII: ENDOCRINE The Thyroid The Parathyroid Gland Endocrine Pancreas The Pituitary and Adrenal Glands The Multiple Endocrine Neoplasia Syndromes SECTION IX: ESOPHAGUS Esophagus Hiatal Hernia and Gastroesophageal Reflux Disease SECTION X: ABDOMEN Abdominal Wall, Umbilicus, Peritonoeum, Mesenteries, Omentum & Retroperitoneum Hernias Acute Abdomen Acute Gastrointestinal Hemorrhage Stomach Small Bowel The Appendix Colon and Rectum Anus The Liver Surgical Complications of Cirrhosis & Portal Hypertension Biliary Tract Exocrine Pancreas The Spleen SECTION XI: CHEST Chest Wall and Pleura The Mediastinum Lung/Pulmonary Embolism Congenital Heart Disease Acquired Heart Disease: Coronary Insufficiency Acquired Heart Disease: Valvular SECTION XII: VASCULAR Thoracic Vasculature Cerebrovascular Disease Aneurysmal Vascular Disease Peripheral Arterial Occlusive Disease Vascular Trauma Venous Disease The Lymphatics Access and Ports SECTION XIII: SPECIALTIES IN GENERAL SURGERY Pediatric Surgery Neurosurgery Plastic Surgery Hand Surgery Emergent Care of Musculoskeletal Injuries Gynecology & The Female Reproductive Organs Urology

Abstract: Acute epiploic appendagitis most commonly manifests with acute lower quadrant pain. Its clinical features are similar to those of acute diverticulitis or, less commonly, acute appendicitis. The conditions that may mimic acute epiploic appendagitis at computed tomography (CT) include acute omental infarction, mesenteric panniculitis, fat-containing tumor, and primary and secondary acute inflammatory processes in the large bowel (eg, diverticulitis and appendicitis). Whereas the location of acute epiploic appendagitis is most commonly adjacent to the sigmoid colon, acute omental infarction is typically located in the right lower quadrant and often is mistaken for acute appendicitis. It is important to correctly diagnose acute epiploic appendagitis and acute omental infarction on CT images because these conditions may be mistaken for acute abdomen, and the mistake may lead to unnecessary surgery. The CT features of acute epiploic appendagitis include an oval lesion 1.5-3.5 cm in diameter, with attenuation similar to that of fat and with surrounding inflammatory changes, that abuts the anterior sigmoid colon wall. The CT features of acute omental infarction include a well-circumscribed triangular or oval heterogeneous fatty mass with a whorled pattern of concentric linear fat stranding between the anterior abdominal wall and the transverse or ascending colon. As CT increasingly is used for the evaluation of acute abdomen, radiologists are likely to see acute epiploic appendagitis and its mimics more often. Recognition of these conditions on CT images will allow appropriate management of acute abdominal pain and may help to prevent unnecessary surgery.

Abstract: This paper reports a controlled trial of human and computer-aided diagnosis in a series of 552 patients with acute abdominal pain. The overall diagnostic accuracy of the computer-aided system was 91.5% and that of the senior clinician to see each case was 81.2%. However, the clinician's diagnostic performance improved markedly during the period of the trial. The proportion of appendices which perforated before operation fell from 36% to 4% during the trial, and the negative laparotomy rate dropped sharply. After the trial closed in August 1972 these figures reverted towards their pretrial levels.It is suggested that while computer-aided diagnosis is a valuable direct adjunct to the clinician dealing with the "acute abdomen," he may also benefit in the short-term from the constant feedback he receives and from the disciplines and constraints involved in communicating with the computer.