DIAGNOSTIC ACCURACY OF ULTRASOUND IN ACUTE ABDOMINAL PAIN: COMPARISON WITH INTRA-OPERATIVE FINDINGS AT A TERTIARY CARE CENTER
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Keywords
Ultrasound; diagnostic accuracy; acute abdominal pain; intraoperative findings; surgical abdomen
Abstract
: Ultrasonography is widely utilized as a first-line imaging modality for evaluating acute abdominal pain due to its accessibility, safety, and real-time assessment capabilities. However, its diagnostic accuracy varies across different pathological conditions. This study aimed to assess the diagnostic accuracy of abdominal ultrasound by comparing preoperative ultrasound findings with definitive intraoperative surgical findings in patients with acute abdominal pain.
Methods: This prospective observational diagnostic accuracy study was conducted at Vyas Medical College and Hospital, Jodhpur, from January 2025 to July 2025. A total of 145 adult patients presenting with acute abdominal pain who underwent both abdominal ultrasound examination and subsequent surgical intervention were enrolled through consecutive sampling. Ultrasound findings were systematically documented and compared with intraoperative surgical observations as the reference standard. Diagnostic accuracy parameters including sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated. Statistical analysis was performed using SPSS version 26.0.
Results: The overall diagnostic accuracy of ultrasound was 86.2%, with sensitivity of 79.3% and specificity of 90.5%. Condition-specific accuracy varied significantly: acute cholecystitis (95.2% accuracy, 92.9% sensitivity), intestinal obstruction (93.1% accuracy, 88.9% sensitivity), acute appendicitis (84.1% accuracy, 78.8% sensitivity), and perforation peritonitis (84.8% accuracy, 54.5% sensitivity). Cohen's kappa demonstrated substantial agreement (0.78) between ultrasound and surgical findings. Obesity, excessive bowel gas, and prolonged symptom duration were significantly associated with diagnostic discordance. Acute appendicitis was the most common surgical diagnosis (35.9%), followed by acute cholecystitis (19.3%) and perforation peritonitis (15.2%). Conclusion: Ultrasound demonstrates good overall diagnostic accuracy for acute abdominal pain with excellent performance for biliary pathology and intestinal obstruction. However, limitations exist for detecting perforation, necessitating clinical correlation and judicious use of complementary imaging modalities.
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Dr Shyam Sunder Vaishnav
Assistant Professor, Department of General Surgery, Vyas Medical College and Hospital, Jodhpur, Rajasthan, India.