Department of Radiology, University of Washington, Seattle, WA, 98105, USA.
Department of Radiology, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
Abdom Radiol (NY). 2016 Jan;41(1):136-48. doi: 10.1007/s00261-015-0586-6.
"Acute abdomen" includes spectrum of medical and surgical conditions ranging from a less severe to life-threatening conditions in a patient presenting with severe abdominal pain that develops over a period of hours. Accurate and rapid diagnosis of these conditions helps in reducing related complications. Clinical assessment is often difficult due to availability of over-the-counter analgesics, leading to less specific physical findings. The key clinical decision is to determine whether surgical intervention is required. Laboratory and conventional radiographic findings are often non-specific. Thus, cross-sectional imaging plays a pivotal role for helping direct management of acute abdomen. Computed tomography is the primary imaging modality used for these cases due to fast image acquisition, although US is more specific for conditions such as acute cholecystitis. Magnetic resonance imaging or ultrasound is very helpful in patients who are particularly sensitive to radiation exposure, such as pregnant women and pediatric patients. In addition, MRI is an excellent problem-solving modality in certain conditions such as assessment for choledocholithiasis in patients with right upper quadrant pain. In this review, we discuss a multimodality approach for the usual causes of non-traumatic acute abdomen including acute appendicitis, diverticulitis, cholecystitis, and small bowel obstruction. A brief review of other relatively less frequent but important causes of acute abdomen, such as perforated viscus and bowel ischemia, is also included.
“急腹症”包括一系列从病情较轻到危及生命的医学和外科病症，这些病症的患者都表现为在数小时内出现严重腹痛。准确和快速诊断这些病症有助于减少相关并发症。由于存在非处方止痛药，临床评估通常很困难，导致身体检查结果不那么具有特异性。关键的临床决策是确定是否需要手术干预。实验室和常规放射影像学检查结果往往不具有特异性。因此，横断面成像在帮助指导急腹症的管理方面起着关键作用。由于快速采集图像，计算机断层扫描是这些病例的主要成像方式，尽管超声对于急性胆囊炎等病症更具特异性。对于特别容易受到辐射暴露的患者（如孕妇和儿科患者），磁共振成像或超声非常有帮助。此外，在某些情况下，磁共振成像也是一种出色的解决问题的方式，例如在右上腹疼痛的患者中评估胆总管结石。在本综述中，我们讨论了非创伤性急腹症的常见病因的多模态方法，包括急性阑尾炎、憩室炎、胆囊炎和小肠梗阻。还简要回顾了其他相对较少见但重要的急腹症病因，如穿孔性内脏和肠缺血。
