Diagnosis in acute abdominal pain and ongoing abdominal sepsis

Acute abdominal pain is a common reason for presentation at the emergency department. To establish a timely and adequate diagnosis, doctors use the pattern of complaints and physical examination as the basis for the evaluation of a patient. In this thesis we conducted a study that showed that surgeons with more experience than surgical residents have a similar diagnostic accuracy. Furthermore, when surgical residents used decision tools for appendicitis and diverticulitis, it did not increase diagnostic accuracy and certainty. Additional resources such as laboratory tests, ultrasonography, X-ray and computed tomography scanning can be used to increase diagnostic accuracy. We conducted several studies to evaluate the additional value of these resources on the diagnostic accuracy in different diagnosis such as cholecystitis, diverticulitis and intestinal ischemia.
Certain causes of acute abdominal pain can cause peritonitis for which a laparotomy is necessary. Despite this operation, some of these patients need a relaparotomy because of ongoing peritonitis. However, identifying those who need a relaparotomy is challenging. We conducted several studies to uncover parameters and to evaluate decision tools that are predictive of ongoing peritonitis needing relaparotomy. It proved difficult to uncover predictive factors and provide a simple decision tool to identify these patients. Clinicians involved in the care for these patients are in need of a guideline that includes multidisciplinary discussion and description of how intensive monitoring should be conducted.