The acute abdomen: Plain radiographic evaluation

There is still a significant role for plain radiographs of the abdomen in the workup of patients with an acute abdomen, and we believe that radiographs of the abdomen are a reasonable place to start the imaging evaluation of these patients. In patients suspected of having acute cholecystitis, the demonstration of opaque gallstones or of an obvious soft tissue mass in the region of the gallbladder is obviously important. In the rare patient with emphysematous cholecystitis, the demonstration of gas in the wall or lumen of the gallbladder, or both, can be diagnostic. Specific plain radiographic findings of splenic trauma are unusual, but plain radiographs may demonstrate rib fractures or other skeletal injuries that raise one's index of suspicion with respect to the possibility of splenic rupture. Plain radiographs may also demonstrate splenic enlargement or free peritoneal fluid. These findings strongly suggest splenic trauma. Plain radiographs of the abdomen in a postoperative patient may demonstrate gas in a subhepatic abscess that has not been suspected clinically. Any loculated collection of gas above the proximal transverse colon is an indication for further imaging evaluation. Contrast studies of the gastrointestinal tract can define leaks and perforations that cannot be diagnosed preoperatively by any other technique.