An “acute abdomen” denotes any sudden, spontaneous, nontraumatic, severe abdominal pain, typically of less than 24 hours duration

1. Dr. Sharan Khan &
Dr. Tanvir Kabir
Intern Doctor
Department of Surgery
Enam Medical College Hospital

2. Introduction
An “acute abdomen” denotes any
sudden, spontaneous,
nontraumatic, severe abdominal
pain, typically of less than 24 hours
duration

3. Common causes of acute abdomen
that we encountered generally
A. Gastrointestinal Tract Disorders
 Appendicitis
 Small and large bowel obstruction
 Perforated peptic ulcer
 Acute gastritis
 Mesenteric adenitis

4. Common causes of acute abdomen that
we encountered generally contd.
B. Liver, Spleen, and Biliary Tract Disorders:
 Acute cholecystitis
 Acute cholangitis
 Hepatic abscess
 Ruptured hepatic tumor
 Spontaneous rupture of the spleen
 Biliary colic

5. Common causes of acute abdomen that
we encountered generally contd.
C. Pancreatic Disorders
 Acute pancreatitis
D. Urinary Tract Disorders
 Ureteral or renal colic
 Acute pyelonephritis
 Acute cystitis
E. Vascular disorder
 Ruptured aortic and visceral aneurysms
 Acute ischemic colitis
 Mesenteric thrombosis

6. Imaging help in Diagnosing acute abdomen:
 Abdominal X Ray
 Chest X ray
 Ultrasonography
 Computed tomography scan
 Angiography
 GIT Contrast x ray study
 Radionuclide scan

7. Abdominal X Ray
Common Disorder Finding
Small bowel obstruction •Centrally placed Multiple air fluid
level(Stepladder pattern)
•Valvulae connivent
•Concertina effect
•Diameter > 3 cm of the bowel wall
•Rigler’s triad, comprising: small
bowel obstruction, pneumobilia
and an atypical mineral shadow on
radiographs of the abdomen. In
Gallstone ileus

8. Abdominal X Ray
Common Disorder Finding
Large bowel obstruction •Peripherally placed multiple air fluid level
except for the caecum, shows haustral folds
•unlike valvulae conniventes, they are
spaced irregularly,
•Caecum – a distended caecum is shown by
a rounded gasshadow in the right iliac fossa
•Diameter > 6 cm for colon and > 9 cm for
caecum

9. Abdominal X Ray
Common Disorder Finding
Perforation of gas containing viscus •Subdiaphragmatic cresentic air
shadow
•Multiple air fluid level
•Ground glass appearnace(Due to
free intraperitonela fluid)
•The presence of free
intraperitoneal air outlines the
bowel so that both sides of the
bowel wall can be seen(Rigler’s
sign).

10. Abdominal X Ray
Common Disorder Finding
Acute pancreatitis •Gall stone(10%)
•Pancreatic calcinosis
•Pleural effusion
•Sentinel loop
•Colon cut off sign
•Renal halo
•Ground Glass Appearance
•Loss of psoas shadow(if
retroperitoneal He)
Acute appendicitis Calcified appendicolith in the right
iliac fossa

11. Abdominal X Ray
Common disorder Finding
Gall bladder disease and biliary tree •Gall stone 10%(Sea-gul or Mercedes
Benz sign)
•Porceline gallbladder
•Emphysematous cholecystitis
•Pneumobilia( After ERCP, Gallstone
ileus, bilio-enteric anastomosis)
Ischemic colitis Thumbprint sign
Renal colic Demonstrate all calculi with site
except uric acid stone

12. Chest X ray
Common Disorder Finding
Perforation of gas containing
viscus
a. Subdiaphragmatic
cresentic air shadow
b. Pleural effusion
c. Elevated hemidiaphragm.
Acute pancreatitis Pleural effusion

13. Ultrasonography:
Common disorder Finding
Acute appendicitis(Retrocaecal
appendicitis can readily escape
detection with ultrasound)
1. Periappendiceal collection
2. Thickened appendix (>7 mm) in pt
who are lean and thin and children
3. Inflammatory mass(Appendicular
lump)
Acute Pancreatitis 1. Enlarged pancreas
2. Peripancreatic fluid and
inflammatory changes
3. Pancreatic calcinosis
4. Pancreatic duct dilatation
5. Free fluid
6. Pancreatic pseudocyst
7. It can be used to guide
percutaneous drainage of
inflammatory fluid collections

14. Ultrasonography:
Common disorder Finding
Perforation of hollow viscus 1. Thickened edematous bowel wall
2. Aperistaltic intestine(Ileus)
3. Free intraperitoneal fluid
Bowel obstruction 1. Dilated thickened bowel wall
2. Mass lesion if present
3. Ascitic fluid
Abdominal aortic aneurysm extent and exact size of aneurysm for
surveillance and for treatment plan
Renal colic 1. demonstrate all calculi
2. Site of calculi
3. demonstrate hydronephrosis and
hydroureter
4. Renal parenchymal change

15. Ultrasonography:
Common disorder Finding
Acute cholecystitis with biliary pathology 1. Pericholecystic fluid
2. Thickened(>3mm), distension or
fibrosed gall bladder wall
3. Gall stone, size site of impaction
4. Common bile duct dilatation or stone
5. Ultrasonographic Murphy’s
sign(Tenderness on application of
probe)
6. Gall bladder perforation with
subhepatic collection

16. Computed tomography scan
Common disorder Finding
Acute appendicitis 1. Periappendiceal collection
2. Thickened appendix (>7 mm) in pt who are lean and
thin and children
3. Inflammatory mass(Appendicular lump)
4. thickening of the caecal pole,
5. possible localised small bowel ileus and
6. right iliac fossa lymphadenopathy.
Acute pancreatitis 1. enlarged oedematous gland
2. peripancreatic fluid collections
3. vascular complications such as arterial
pseudoaneurysm formation or venous
thrombosis and necrosis either of the gland itself
or of the surrounding fat.
4. CT can be used to guide percutaneous drainage
of inflammatory fluid collections.

17. Computed tomography scan
Common disorder Findings
Acute cholecystitis/biliary
colic/jaundice
1. gangrenous cholecystitis, gallbladder
perforation and emphysematous cholecystitis
2. to look for common causes including stones,
cholangiocarcinoma and pancreatic
carcinoma.
3. CBD stone, diameter other pathology
Intestinal Obstruction 1. Dilated thickened bowel wall
2. Mass lesion, origin and extension
3. Free intraperitoneal fluid

18. Computed tomography scan
Common Disorder Findings
Renal Colic – CT Urogram 1. Stone(Site, size, number)
2. Hydroureter, hydronephrosis
3. Excretory function
4. Renal parenchymal change
Perforation of hollow
viscus
show tiny quantities of free air and also identify cause
Ischemic colitis bowel wall thickening, submucosal oedema and free
fluid between the folds of the mesentery (particularly if
haemorrhagic).

19. Angiogram:
CT angiography (CTA), percutaneous invasive angiographic
studies, or magnetic resonance angiography (MRA), are
indicated if
 intestinal ischemia or
 ongoing hemorrhage are suspected
It confirm a ruptured liver adenoma or carcinoma or an aneurysm of thesplenic
artery or other visceral artery.
it can be used for therapeutic purpose i.e – embolization
MRA(Magnetic resonance angiogram) is useful when a
patient is unable to undergo IV contrast administration
(due to either renal impairment or contrast dye allergy).

20. GIT Contrast x ray study with Urinary system
 For suspected perforations of the esophagus or
gastroduodenal area without pneumoperitoneum, a
water-soluble contrast medium (eg, meglumine
diatrizoate [Gastrografin]) is preferred.
 If there is no clinical evidence of bowel perforation, a
barium enema may identify the level of a large bowel
obstruction or even reduce a sigmoid
volvulus(Pneumatic tire like shadow arises from pelvis,
coffee bean sign) or intussusceptions(Claw sign).
 IVU- Space occupying lesion, filling defect, stone,
hydroureter, hydronephrosis, excretory function are
assessed.

21. Radionuclide scan
 RBC Scan for occult, slow or intermittent GIT
Bleeding
 Technetium scan for Ectopic gastric mucosa in
Meckels diverticulitis
 Galium 67 to detect occult intrabdominal abscess
or infection
 HIDA scan for acute cholecystitis or bile leakage.

22. Figure 1 : Erect chest radiograph showing marked bilateral elevation of
the hemidiaphragms with a large volume of subdiaphragmatic free
gas.

23. Figure 2 : Pneumoperitoneum. The presence of free intraperitoneal air outlines the
bowel so that both sides of the bowel wall can be seen (Rigler’s sign).

24. Figure 3: LEFT: Plain abdominal film in a patient with an acute abdomen, showing no
abnormalities. RIGHT: Subsequent CT shows distended small bowel loops (arrowheads)

25. Figure 4 : Multiple air fluid level in Small bowel obstruction

26. Figure 5 : subdiaphragmatic free gas(PGCHV)

27. Figure 6: Gall bladder stone

28. Figure 7: Colon cut off sign in acute pancreatitis

29. Figure – 8 Plain X Ray KUB Showing Bilateral renal stone

30. Figure 9 CT-scan 10 days after admission: Necrotic pancreatic tissue and
peripancreatic fluid collections.

31. Figure 10 IVU Showing Renal stone

32. Figure 11: USG showing gall stone

33. Figure 12: CT scan of perforation of gas containing hollow viscus

34. Figure 13: CT Urogram showing filling defect

35. Figure 14: Plain X ray Showing
sigmoid volvulus

36. Figure 15: Barium enema

37. Figure: 16 HIDA Scan

38. Figure 17 : Isotope scan for
Meckel’s Diverticlum

39. Kasper
 This four and half year old boy well
known as a trekker and also named choto
Vhoot(little ghost).
 Suddenly developed per rectal bleeding
and first operated in Chittagong but
failed to identify the cause of Hge.
 The condition of Kasper worsed day by
day….no Doctor/Surgeon identify the
cause…
 Finally Kasper Landed in Dhaka….
 In BSMMU second Exploratory
laparotomy done and that time they
identify “Meckel’s Diverticulum”

40.  In BSMMU They did excision of the meckel’s
diverticulum.
 But post operatively suddenly He developed ARDS and
shifted To ICU then leave the world………..