IntroductionCHAPTER 1

Early and accurate diagnosis is essential to minimize morbidity and mortality. The clinical analysis of acute abdomen is challenging because the clinical symptoms, physical signs and laboratory findings are not always diagnostic and are often nonspecific. Delay in diagnosis results in severe complications, increased hospital stay and postoperative complications. Also the spectrum of differential diagnosis is numerous ranging from minor self-limiting disorders to catastrophic conditions requiring immediate operation and intervention.²

Imaging plays a vital role³ in acute and early diagnosis helps prevent complications, surgical interventions and hospital cost, negative laparotomies, reduced cost and hospital stay.

Plain film radiography and sonography form the initial mode of investigation—plain films can be used to detect free air or pattern of bowel gas distribution or abnormal calcification, however they are limited in specificity.

Although sonography⁴ is well-established in evaluation of gallbladder disorders in children and women of child-bearing age, it is limited by the presence of bowel gas, body habitus, is operative dependent and difficult for the clinicians to understand

Helical CT is fast-evolving^5–7 as an effective technique for evaluation of acute abdomen. CT is rapid, less-invasive, not affected by bowel gas or abdominal fat. It can cover 3a wide range of abnormalities including gut, mesentery, omentum, peritoneum and retroperitoneal pathologies. Further more, 3-dimensional depictions helps clinicians understand the pathology better and help management.

The subsequent chapters will describe the practical approach and salient features of CT in acute abdominal disorders.