Is routine abdomen tomography necessary in patients with a history of abdominal surgery or brid ileus and clinically considered with ileus in the emergency department?

Introduction: Abdominal pain is one of the most common reasons for frequent visits to emergency departments. Early and accurate recognition of abdominal pain has a direct impact on mortality and morbidity. Abdominal pain, often associated with nausea and vomiting, can range from dyspeptic complaints to perforation. The primary aim of this study is to determine the role of abdominal tomography in patients diagnosed with ileus by history, physical examination and outpatient abdominal radiography (OABR) in the emergency department (ED) and who have a history of abdominal surgery or obstructive ileus. Materials and Methods: The study was conducted by identifying patients who presented to the emergency department of Akdeniz University Hospital with abdominal pain between 1 January 2022 and 31 December 2022 through the hospital information management system. Demographic data, clinical characteristics and imaging information of the patients were collected. Patient follow-up and outcomes were recorded for analysis. Results: A total of 158 participants were included in the study. All participants had evidence of air-fluid levels on standing abdominal radiographs. Females accounted for 50% of the patients with a mean age of 60.22±16.27 years. While 39.2% of patients had a history of malignancy, 98.7% had a history of previous abdominal surgery. 84.8% of patients were hospitalised and 2.5% had a fatal outcome. There was a significant difference between the presence of additional findings on CT and patient outcome (p=0.043). The odds ratio for a history of malignancy affecting the presence of additional pathology on CT was 2.67, while the odds ratio for the presence of tenderness was calculated to be 2.79. The types of additional pathology were found to significantly influence the frequency of surgical intervention in patients. Conclusion: The results of our study indicate that a known history of malignancy in patients, the detection of abdominal tenderness and guarding on physical examination suggest the possibility of additional pathology, and that additional pathology has a significant impact on patients requiring surgical intervention. This highlights the importance of history taking and physical examination in the assessment of patients to determine the need for abdominal CT and the likelihood of undergoing surgery. Keywords: Ileus, Emergency Department, Mortality.