Emergency Medicine

Answer 4 Abdominal radiographs are most useful in the diagnosis of intestinal obstruction. Plain film abdominal radiographs are often ordered for the wrong reason. The only clinical entities for which the sensitivity of abdominal radiographs approaches 100% are bowel obstruction and free intraperitoneal air. One large study demonstrated little value in using abdominal radiographs for patients with suspected appendicitis, nonspecific abdominal pain, and gastrointestinal bleeding and biliary colic.6 An upright chest radiograph can detect as little as 1 mL of free air and is superior to an upright abdominal radiograph in detecting free air. Newer imaging studies such as ultrasonography and computed tomography play a role in the diagnosis of acute abdominal pain when ordered appropriately. REFERENCE 6. Campbell JP, Gunn AA: Plain abdominal radiographs and acute abdominal pain. Br J Surg 1988;75:554­556. Click here to return to the questions

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