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J Korean Soc Emerg Med > Volume 28(6); 2017 > Article
Journal of The Korean Society of Emergency Medicine 2017;28(6): 665-675.
비외상성 복통으로 응급실에 내원한 가임기 여성에서 검사실 결과가 정상인 경우 외과적 복증 감별 인자에 대한 분석
송형준, 이준희
원광대학교 의과대학 산본병원 응급의학과
Analysis of Differential factors for Detecting Surgical Acute Abdomen in Women of Childbearing Age Presenting to the Emergency Department with Non-traumatic Abdominal Pain in the Absence of Laboratory Abnormalities
Hyung Jun Song, Jun Hee Lee
Department of Emergency Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
Correspondence  Jun Hee Lee ,Tel: 031-390-2269, Fax: 031-390-2348, Email: Inhaed@gmail.com,
Received: June 21, 2017; Revised: August 28, 2017   Accepted: September 21, 2017.  Published online: December 31, 2017.
ABSTRACT
Purpose:
Acute abdomen in women of childbearing age has a broad differential diagnosis, often presenting a diagnostic challenge to an emergency physician. Computed tomography (CT) has been used for an accurate diagnosis and prompt treatment of acute abdomen. On the other hand, the increasing use of CT has been a subject of concern for patients, particularly women of childbearing age, due to the potential risk of radiation exposure. This study analyzed the efficacy of various physical examinations for detecting surgical acute abdomen in women of childbearing age who presented with non-traumatic abdominal pain in the absence of laboratory abnormalities.
Method:
The charts and CT reports of women, aged 15-35 years old, who visited our ED for non-traumatic abdominal pain between May 2011 and April 2017 were reviewed retrospectively. Patients with chronic abdominal disease, pregnancy, recent abdominal surgery within one month, and abnormal laboratory tests were excluded.
Results:
In total, 121 patients were identified, of which 34 patients fell into a group that required surgical intervention (surgical acute abdomen group). The remaining 87 patients were managed conservatively without surgical intervention (non-surgical acute abdomen group). The maximal tenderness point (p=0.006), rebound tenderness (p=0.001), shorter duration of abdominal pain (p<0.001), and absence of diarrhea (p=0.001) were statistically significant for predicting the need for surgical intervention.
Conclusion:
In the absence of abnormal laboratory studies, the hypogastrium tenderness point, rebound tenderness, duration of abdominal pain, and diarrhea were found to be independently valid factors for detecting surgical acute abdomen in women of childbearing age who presented with non-traumatic abdominal pain.
Key words: Acute abdomen, Women, Abdominal pain, Hospital emergency services, Laboratories
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