Ultrasonography in the Diagnosis of Surgical Acute Abdomen in Zaria, Nigeria.

INTRODUCTION

The purpose of the study was to determine the spectrum of diseases of surgical acute abdomen by ultrasonography and comparing the ultrasound diagnosis with the surgical diagnosis of acute abdominal conditions in a low-income resource setting.

MATERIALS AND

METHODS

A prospective observational study was conducted on consecutive patients presenting with acute abdomen to the radiology department for abdominal ultrasonography. The ultrasound diagnosis was compared with the surgical diagnosis. Chi-square and Fisher's exact tests were used for association, and Kappa statistics was used for interobserver agreement. Diagnostic performance markers included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy.

RESULTS

The most common conditions included appendicitis (27.5%), bowel perforation (21.7%), and ectopic pregnancy (12.5%). Ultrasonography had an overall sensitivity of 80.8%, specificity of 99.1%, PPV of 89.0%, NPV of 98.3%, and diagnostic accuracy of 97.6%. Sensitivities of 69.7%, 88.5%, 100.0%, and specificities of 98.9%, 96.8%, 100.0% were seen for acute appendicitis, bowel perforation, and ectopic pregnancy, respectively. There was a significant relationship between ultrasound and surgical diagnosis of most of the acute abdominal conditions ( P < 0.001) except for appendiceal abscess ( P = 0.05). Ultrasound and surgical diagnosis of all the acute abdominal conditions showed beyond chance kappa (κ) interobserver agreement (0.20< κ ≤1.00).

CONCLUSION

With skilled hands, there is high concordance between ultrasound and surgical diagnosis of acute abdomen. Ultrasonography should be part of the initial evaluation of patients with surgical acute abdomen in a setting where emergency abdominal computed tomography is not readily available, accessible, and affordable.