Krishna Kishore G¹, Srinivas Rao Mandalapu^2*

¹Assistant Professor, ²Associate Professor, Department of Surgery, SVS Medical College: Mahabubnagar: Telangana, INDIA.

Email: drmsraoms1@gmail.com

RESULTS

300 patients were included in the study.

Table 1: Distribution based on age.

Table 1 shows that majority of patients were in the age group of 16-31 years (58.3%), 30.7% were in the age group of 32-51 years, 11% were above 51 years.

Table 2: Distribution based on sex.

Table 2 shows that majority were males which were 65.6% and females were 34.4%.

Table 3: Distribution based on pain.

Table 3 shows that 32% of patients showed sudden onset of pain and 68% of patients showed pain more than 3 days.

Table 4: Distribution based on comorbidity.

Table 4 shows that 5% of patients had hypertension, 7% had type 2 diabetes, 1% had IHD, 4% had post laparotomy, 3% had malignancy and 1% had tuberculosis.

Table 5: Distribution based on etiology of acute abdomen of patients presenting to an emergency.

Table 5 shows that the etiology of acute abdomen in patients presenting during an emergency was observed as acute appendicitis and was observed to be majority in 31.7% of patients.

Table 6: Distribution of complications of patients.

Table 6 shows that metabolic acidosis was the most common complication observed in 7.7% of patients.

Table 7: Mortality among patients.

Table 7 shows that a mortality rate of 1.7% was observed in the study.

DISCUSSION

"An abnormal condition characterized by a quick onset of severe pain within the abdominal cavity that demands immediate evaluation, diagnosis, and may require surgical intervention," according to the definition of immediate acute abdomen. The first record exterostomy is thought to have been performed by Paraxegoras. Pierre franeo advised surgery for an inguinal hernia as early as 1556⁵. In the treatment of strangulated inguinal hernias, he advocated surgical surgery. Jaharn Friedrich Dieffenbach did not disclose the successful removal of gangrenous bowel in a strangulated hernia until 1836.⁶ The adoption of a surgical line of therapy for acute duodenal ulcer perforation, along with the advent of antibiotics and relaxant anesthesia, has resulted in a progressive decrease in fatality rates, from 4% in 1953 to 2% in 1960. The entire abdominal cavity or a section of the visceral or parietal peritoneum can be affected by peritonitis. Transudation can result in an increase in peritoneal fluid, which is high in protein and leukocytes, making it easier for fibrin to develop on peritoneal surfaces. 5 Peritonitis refers to any type of peritoneal inflammation. Peritonitis can develop as a widespread bacterial infection without a clear intra-abdominal source of contamination in primary or spontaneous peritonitis. Children are more likely than adults to develop primary peritonitis, which is most usually caused by Pneumococcus or hemolytic Streptococcus. Adults with ascites and cirrhosis, on the other hand, are vulnerable to Escherichia coli and Klebsiella-induced peritonitis. Perforation, infection, or gangrene of an intra-abdominal organ, most commonly the gastrointestinal system, causes secondary peritonitis. The normal structure of the abdominal cavity and its viscera is determined by the developmental architecture of the abdominal cavity and its viscera, which influences the pathophysiology and clinical symptoms of most abdominal disorders. Extensive diagnostic tests are not required for all people with stomach pain. In some cases, a thorough history and physical examination are enough to accurately identify and treat an illness. Patients may appear with a variety of ambiguous complaints and symptoms, making identification of illnesses ranging from benign to life-threatening problematic. In the present study, more than half of them said their discomfort started suddenly, while the other half said it started gradually. Similar results were observed in Dr. Naveed Anjum Qureshi et al. study.⁷ In the present study, the etiology of acute abdomen in patients presenting during an emergency was observed as acute appendicitis and was observed to be majority in 31.7% of patients. In Tariq et al.⁸ study, Acute appendicitis was the most common cause of acute abdomen, followed by acute pancreatitis and duodenal ulcer. In OheneYeboah M et al.⁹ study; the most prevalent causes of acute abdominal discomfort were documented to be acute appendicitis, typhoid fever, ileal perforation, and acute intestinal obstruction. In Dr. Ritesh Gajjar et al.¹⁰ study, the most common reasons for ED visits due to abdominal pain were ureteric colic (22%), acute gastroenteritis (11%), acid peptic disease (11%), UTI (7%), hollow viscus perforation (08%) and acute appendicitis (07%). In Selbst SM et al.¹¹ and Kachalia A et al.¹² studies; approximately 73 percent of the patients with acute appendicitis were under the age of 25. The presenting issue in a large majority of medicolegal lawsuits against both general and pediatric EM practitioners is abdominal pain. In Flum DR et al.¹³ study; the fact that, despite diagnostic and therapeutic improvements (computed tomography [CT], ultrasonography, and laparoscopy), the misdiagnosis rate of the most common surgical emergency, acute appendicitis, has remained relatively constant throughout time should embarrass the modern physician. In roughly 12% of instances, no particular diagnosis was found. According to Wong et al.,¹⁴ conditions like dengue can produce stomach discomfort, therefore looking for an abdominal source of abdominal pain may be useless. Special groups of people, such as pregnant women and the elderly, appear in different ways, making the approach even more complex. Designing a common approach to acute abdominal discomfort is difficult for these reasons. Because this is an ED-based study, gold standards were not used for confirmation of the diagnosis.

CONCLUSION

Acute abdomen is a common emergency room complaint, and numerous intraabdominal disorders have similar symptoms. Aside from easing the patient's symptoms, the primary job of the emergency physician is to identify instances that require prompt action to reduce morbidity and mortality. In a tiny proportion of these individuals, despite a complete history, clinical examination, laboratory, and radiographic studies, diagnosis remains elusive. A patient should be reassessed if a test result is unexpectedly negative. A good technique is to examine patients regularly and identify those who may require immediate investigation.

REFERENCES

• 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. BMJ 2009;338:b2431.
• Agboola JO, Olatoke SA, Rahman GA. Pattern and Presentation of Acute Abdomen in a Nigerian Teaching Hospital. Niger Med J. 2014;55:266–70. [PMCID: PMC4089059] [PubMed: 25013262]
• Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and Pitfalls in the Emergency Department Evaluation of Abdominal Pain. Emerg Med Clin North Am. 2003;21:61–72. [PubMed: 12630731]
• Town send CM. Sabiston textbook of Surgery: The biological basis of modern surgical practice 16 Ed. Singapore: Harcourt Asia PTE Ltd., W. B. Saunders Co., 2001.
• Inderbirsingh, “Alimentary system in Human Embryology”, Ch: 12, Ed 5, Macmillan India limited publication, 1995,175 to 187.
• Chummy S. Sinnatamby, “Introduction to regional anatomy” in Last’s anatomy regional andApplied, Ch:1, Edn 10th, Churchill livingstone publication,1999,1to31.
• Dr. Naveed Anjum Qureshi, Dr. Viney Sambyal; Clinical profile of non-traumatic acute abdomen at a tertiary care hospital- a retrospective study; International Journal of Medical and Biomedical Studies; Volume 3, Issue 4; April: 2019; Page No. 135-138.
• Muhammad TA, Asma H, Waqar SH, Shah SF, Zafar IM, Zahid MA. Presentation and Outcome of Acute Abdomen in a Tertiary Care Unit. Ann Pak Inst Med Sci. 2011;7:137–44. 10.
• OheneYeboah M. Acute surgical admissions for abdominal pain in adults in Kumasi, Ghana. ANZ J Surg. 2006;76:898–903. [PubMed: 17007619].
• Dr. Ritesh Gajjar, Dr. P.B.Gupta, Dr. Diwakar Verma, Dr. Binod Gouda; Pattern and Presentation of Non-Traumatic Acute Abdominal Pain to an Emergency Department of a Tertiary Care Hospital; International Journal of Health Sciences and Research; Vol 7; Issue:5; May 2017.
• Selbst SM, Friedman MJ, Singh SB. Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers. Pediatr Emerg Care. 2005;21:165–169. [PubMed]
• Kachalia A, Gandhi TK, Puopolo AL, et al. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Acad Emerg Med.2007;49:196–205. [PubMed]
• Flum DR, Morris A, Koepsell T, et al. Has misdiagnosis of appendicitis decreased over time? JAMA. 2001; 286:1748–1753. [PubMed]
• Wong JG, Gan VC, Ng EL, Leo YS, Chan SP, Choo R, et al. SelfReported Pain Intensity with the Numeric Reporting Scale in Adult Dengue. PloS One. 2014;9: e96514.