In this thesis several aspects on the diagnosing and management of patients with acute abdominal pain are investigated. 1; The efficacy and safety of standard outpatient re-evaluation for patients... Show moreIn this thesis several aspects on the diagnosing and management of patients with acute abdominal pain are investigated. 1; The efficacy and safety of standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain. 2; The use of a diagnostic strategy for patients clinically suspected to have appendicitis incorporating non-invasive modalities such as clinical evaluation, routine ultrasound and clinical re-evaluation, and a minimal use of complementary CT or laparoscopy. 3; The possibility to clinically differentiate between children with acute appendicitis and those with acute mesenteric lymphadenitis. 4; The value of secondary signs during the ultrasonographic evaluation of children with suspected appendicitis. 5; The impact of radiological imaging on diagnostic accuracy and clinical decision making for patients with acute colonic diverticulitis. 6; A systematic review on laparoscopic peritoneal lavage for patients with peritonitis due to perforated colonic diverticulitis. Show less
In this thesis the assessment of ultrasonography (US) and Computed Tomography (CT) in the diagnostic strategy of suspected appendicitis is presented. The first study showed that focused single... Show moreIn this thesis the assessment of ultrasonography (US) and Computed Tomography (CT) in the diagnostic strategy of suspected appendicitis is presented. The first study showed that focused single-detector helical CT as well as graded compression US performed in a general community teaching hospital by both body imaging radiologists and general radiology staff members have a similar accuracy for the diagnosis of acute appendicitis. A second study showed that in interpreting CT images the expertise of the attending radiologist should be considered. A third study showed that gender seems to affect the accuracy of US and CT in patients suspected of acute appendicitis. A fourth study showed that US as a sole imaging tool is of limited value both in women with unequivocal and in women with equivocal signs of appendicitis. A fifth study showed that US and CT implemented in a diagnostic pathway yields a high diagnostic accuracy for acute appendicitis without adverse events due to delay in treatment. A sixth study showed that for a majority of the surgeons, the diagnosis of acute appendicitis is based on clinical signs and symptoms. US and CT can be valuable in diagnosing appendicitis but further cooperation between surgeons and radiologists is required. Show less
