Nazia Azeem



To find out the usefulness of plain radiograph comparing with advance imaging in non-traumatic acute abdominal emergencies in a limited resource private set up.

STUDY DESIGN: Cross sectional study

STUDY PLACE AND DURATION: Emergency Department in collaboration of Department of Radiology, Sir Syed Hospital Karachi, a private tertiary care center. Six months from 1st August 2017 to 31st January 2018.


Total 204 patients presenting in ER department with non-traumatic acute abdominal pain were enrolled in the study referred to the Radiology department for imaging were recorded on proforma. SPSS version 20.0 was used for data analysis. Patients demographic data, precipitating symptoms and diagnostic findings were presented as percentages.    


Plain x-ray correctly detected bowel obstruction 97.9% followed by gastroenteritis  88.2%, hernia 80%, peritonitis 75%, acute pancreatitis 55.6%, acute cholecystitis 50%, renal calculus 44.4%, ureteral calculus 36.4% and acute appendicitis 26.3%, but could not suspect about gynecological issues. Plain x-ray correctly diagnosed 151 (74.02%), ultrasound 189 (92.65%) and CT 201 (98.5%).


Abdominal radiography & ultrasonography along with precipitating factors and pathology lab findings still useful as a first imaging examination to evaluate abdominal pain in the emergency department (ED) and reduces rate of unnecessary hospitalization.

KEYWORDS: Acute, abdominal pain, diagnosis, radiography, ultrasonography

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Lameris W, van Randen A, van Es HW, van Heesewijk JP, van Ramshorst B, Bouma WH et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. Brit Med J 2009;339:2431.

Kulla M, Kraus S, Walcher F, Somasundaram R, Wrede CE, Lampl L et al. Patients with Acute, Non-Traumatic Abdominal Pain in German Emergency Departments: A Prospective Monocentric Observation Study. Zentralbl Chir 2016;141(06):666-76.

Gangadhar K, Kielar A, Dighe MK, O'Malley R, Wang C, Gross JA et al. Multimodality approach for imaging of non-traumatic acute abdominal emergencies. Abdom Radiol (NY). 2016 Jan;41(1):136-48.

Mazzei MA, Guerrini S, Squitieri NC, Cagini L, Macarini L, Coppoline F et al. The role of US examination in the management of acute abdomen. Critical Ultrasound Journal 2013 5(Suppl 1):S6.

Kariman H, Shojaee M, Sabzghabaei A, Khatamian R, Derakhshanfar H, Hatamabadi H. Evaluation of the Alvarado score in acuteabdominal pain. Ulus Travma Acil Cerrahi Derg 2014;20:86-90.

Gans SL, Pols MA, Stoker J, Boermeester MA. Guidelines for the diagnostic pathway in patients with acute abdominal pain. Digest Surg 2015;32:23-31.

Durand G, Bounes V, Lauque D. Chronicization of non-traumatic acute abdominal pain in emergency department: Incidence and predictive factors. Ann Fr Med Urgence 2015;5(3):159-65.

Gans SL, Stoker J, Boermeester MA. Plain abdominal radiography in acute abdominal pain; past, present, and future. Inter J Gen Med. 2012;5:525-33.

van Randen A, Laméris W, Luitse JS, Gorzeman M, Hesselink EJ, Dolmans DE et al. The role of plain radiographs in patients with acute abdominal pain at the ED. Am J Emerg Med 2011;29:582-9.

Paolillo C, Spallino I, Cervellin G, Catena F. Is there still a role for abdominal plain X-ray in acute abdomen? Emerg Care J 2015:5528.

Shah H, Parikh C, Raychaudhuri C. Role of Radiology in Evaluation of Non-Traumatic Acute Abdomen. IAIM, 2017; 4(3): 1-9.

Kellow ZS, MacInnes M, Kurzencwyg D. The role of abdominal radiography in the evaluation of the nontrauma emergency patient. Radiology 2008;248:887-93.

Gathwal CK, Gathwal MB, Garg S, Kumari Y, Singh K. A comparative study between abdominal plain radiography and ultrasonography in non-traumatic acute abdominal emergencies in tertiary care hospital. Int J Res Med Sci 2017;5:113-23.

The 2007 recommendations of the international commission on radiological protection. ICRP publication 103.Ann ICRP 2007;37:1–332.

Barksdale AN, Hackman JL, Gaddis M, Gratton MC. Diagnosis and disposition are changed when board-certified emergency physicians use CT for non-traumatic abdominal pain. Am J Emerg Med. 2015 Nov;33(11):1646-50.

Dubuisson V , Voiglio EJ, Grenier N, Le Bras Y, Thoma M, Launay-Savary MV. Imaging of non-traumatic abdominal emergencies in adults. J Visc Surg 2015, 152(6 Suppl):S57-64.

Smith JT, Mbchb M, Parachemant C. The role of imaging in the management of adults with nontraumatic acute abdominal pain. 2009;21:1-19.

Jain R, Gupta V. A prospective study of various available diagnostic and treatment modalities and intraoperative findings of non-traumatic acute abdominal cases in a tertiary care hospital of Central India. J. Evolution Med Dent Sci 2016;5(92):6829-34.

Stroman L, Abdulmajed MI, McDonald C, Chandran P. The role of plain abdominal X-ray in acute surgical setting: a retrospective analysis. Int J Surg 2012;10(8):S46.

Raman S, Somasekar K, Winter R, Lewis M. Are we overusing ultrasound in non-traumatic acute abdominal pain? Postgraduate Medical Journal. 2004;80(941):177-79.

Momin RS, Azhar MA, Hussain S. Clinical and Radiological Diagnosis in Acute Abdominal Emergencies. J. Evolution Med. Dent. Sci. 2015;4(65): 11308-15.

Bhangu A, Richardson C, Winter H, Bleetman A. Value of initial radiological investigations in patients admitted to hospital with appendicitis, acute gallbladder disease or acute pancreatitis. Emerg Med J 2010;27:754-7.

Sharma P, Sidharth, Singh BP, Singh D, Gupta. A Comparative Study between Plain Radiography and Ultrasound Abdomen in Non-Traumatic Surgical Acute Abdominal Conditions NJR. 2012;2(3).

Alshamari M, Norrman E, Geijer M, Jansson K, Geijer H. Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review. Eur Radiol 2016;26:1766–74.

Zeina AR, Shapira-Rootman M, Mahamid A, Ashkar J, Abu-Mouch S, Nachtigal A. Role of Plain Abdominal Radiographs in the Evaluation of Patients with Non-Traumatic Abdominal Pain. Isr Med Assoc J. 2015 Nov;17(11):678-81.

Gulen B, Oktay C, Akpınar G, Sonmez E. The Utility of a Standardized Evaluation Form for Complaints in Patients with Acute Abdominal and Flank Pain. Eurasian J Emerg Med 2016;15:20-3.


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