Acute abdomenJD Wig, RL Basur
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012., India
550 cases of acute abdomen have been analysed in detail including their clinical presentation and operative findings. Males are more frequently affected than females in a ratio of 3: 1. More than 45% of patients presented after 48 hours of onset of symptoms. Intestinal obstruction was the commonest cause of acute abdomen (47.6%). External hernia was responsible for 26% of cases of intestinal obstruction.
Acute abdomen is quite a common surgical emergency and is defined broadly as any acute abdominal episode of enough severity so as to force the patient to seek medical advice.
The object of the present study was to find out the incidence, the aetiological analysis, the evaluation of signs and symptoms, clinical accuracy of the diagnosis and lastly to know the results of management in acute abdomen in our institute hospital (750 bed strength).
All cases of acute abdomen presenting in the emergency service of our hospital over a period of 2 years were studied. During this period, a total of 9625 cases were admitted and out of these 550 cases (5.77c) presenting with acute abdomen were analysed. A special proforma was filled up and cases were analysed according to the aims already mentioned.
This study excluded cases of paediatric age group below 10 years.
[Figure 1] shows the age and sex distribution of the patients studied. Of the 550 cases, 403 were males and 147 females. Their ages varied between 10-70 years and most of them were in the age range of 20-40 years.
The main presenting symptoms were pain associated with vomiting. These patients also had constipation, nausea, distention of abdomen, anorexia and obstipation as shown in [Figure 2].
Duration and Symptoms
45% of patients presented after forty eight hours of onset of symptoms while only 19% presented in the first twelve hours.
17% of cases presented between 1e, and 24 hours whereas 7% presented between 24 and 48 hours after the onset of symptoms.
The aetiological analysis is shown in [Table 1]. Intestinal obstruction was the commonest cause of acute abdomen (37.6%), followed by peritonitis (22.4%), acute appendicitis (21.4%) and cholecystitis (6.0%).
Operative treatment was carried out in 407 patients (74.%) and 143 patients (26.0%) were treated conservatively. Eight per cent of the cases were operated upon within 12 hours of their admission to the hospital. The clinical accuracy rate was 87% in these patients.
Mean hospital stay was two weeks. Forty patients (10%) died after surgery while only one patient died in the conservative treatment group. The overall mortality was 7.5%.
There are a very few reports in the literature, especially in India, on acute abdomen. The few reported series that we have come across are shown in [Table 2].
In our series, intestinal obstruction constituted the major group (37.6%) of acute abdomen. The commonest cause of intestinal obstruction was external hernia (26.0%), [Table 3]. The next commonest cause in our series was adhesions (23.1%). The incidence of volvulus of the bowel in the present series was 17.0%. This is in contrast to the reported series in the Western Literature where the incidence is low 4.7% ,
General peritonitis (22.4%) was the next common cause of acute abdomen in the present series [Table 1]. Perforated peptic ulcer was the major culprit in the causation of peritonitis (31.7%) followed closely by the perforated appendix (25.2%),[Table 4]. Incidence of biliary peritonitis was only 2.4% which is rather low as compared to the reported incidence of 6-25% in the Western Literature. , The incidence of burst amoebic liver abscess causing peritonitis was 3.2%. Enteric perforation of the small intestine constitutes a significant group in our country and was responsible for 7.4% of cases of peritonitis in this study which is in confirmity with the series reported by Bhansali  and Budhraja et al  . The incidence of peritonitis caused by Trauma was 5.7%. In 9.8% of cases, the definitive causative factor could not be ascertained [Table 4].
Acute appendicitis was seen in 117 patients constituting 21.4% of all cases of acute abdomen. These were the cases of acute appendicitis without generalised peritonitis. Taking into consideration the 31 cases of perforated appendix which were responsible for generalized peritonitis the total number of appendicular cases comes to 148 (27%).
The incidence of pancreatitis in the present series was rather low (4.3%). The serum anylase was above 500 units in all these cases.
The incidence of cholecystitis was 6 which is high as compared to reported incidence in the South. This is in consonance with the reported low incidence of gall bladder disease in South India as compared to the North.
The overall mortality rate in the present series was 7.5% while mortality in operated cases was 10%. The higher mortality rate is probably due to the delayed arrival of patients to the hospital, 45/o presenting after 48 hours of onset of symptoms.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]