Role of Multi-slice Computed Tomography in Evaluation of Non-traumatic Causes of Acute Abdominal Pain in Adult Patients with Negative/Inconclusive Sonogram: A Prospective Observational Study

Introduction: Acute non-traumatic abdominal pain is a frequent emergency presentation, associated with a wide range of possible differential diagnoses. While Ultrasonography (USG) is widely available and radiation-free, its diagnostic accuracy is limited by the patient’s habitus and bowel gas. Multi-slice Computed Tomography (MSCT) offers a comprehensive evaluation but comes with a higher cost and increased radiation exposure. Aim: To assess the diagnostic accuracy of MSCT in adult patients with acute non-traumatic abdominal pain negative or inconclusive for USG. Materials and Methods: The present prospective observational study was conducted in the Department of Radiodiagnosis at Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India over a period of one year from June 2024 to July 2025. In this study, 81 adult patients who were referred for CT after an inconclusive/negative USG report underwent contrast-enhanced MSCT using a 128-slice scanner. CT findings were compared with surgical and histopathological outcomes when available, and with clinical follow up in conservatively managed cases. The sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV), as well as the diagnostic accuracy of MSCT in cases of non-traumatic acute abdominal pain were calculated. Results: The mean age was 41.3±15.8 years, out of which 47 (58%) patients were male. MSCT diagnosed 16 (25.9%) cases of pancreatitis, 7 (16%) cases of appendicitis, and 5 (13.6%) cases of ureteric calculi among the most common pathologies. Among the 47 patients who got operated, CT findings were concordant with intraoperative results in 37 (90.2%) patients and with histopathology in all 41 patients (100%). MSCT provided new or alternative diagnosis in 66 out of 81 (81%) cases, significantly altering the management plans. Conclusion: The prompt use of MSCT in cases of an acute abdomen with equivocal USG findings significantly improves diagnostic accuracy and ensures appropriate management, outweighing its higher cost and radiation risks.