Diagnostic Imaging in Surgery

The World Health Organization recommended that the minimum standard radiological equipment is about 20 general radiography units per million people, suggested that approximately 1 Computed Tomography (CT) scan is required for every 10 general radiography units. The X-ray units are the most equitably distributed and accessible resources in low-and middle income countries. Ultrasound (US) use has increased due to improved portability, durability and decreased costs of machines. When CT is not available, patients presenting with generalized acute abdominal pain should undergo a supine abdominal radiography with an erect chest x-ray to confirm a perforated viscus or a bowel obstruction. When CT is available, the abdominal radiography is indicated only in case of foreign body search and confirmation of fecal impaction in the elderly. US examination is the imaging of choice in case of right upper quadrant pain to confirm acute cholecystitis and explore the biliary tree and the liver; in gynecologic and pelvic diseases, in the suspicion of acute appendicitis or to search for abscesses anywhere in the abdomen or pelvis, and in renal colic to assess hydronephrosis. When the contrast enhanced CT is available, it is the imaging technique mandatory to make diagnosis in certain life threatening gastrointestinal emergencies such as in case of acute mesenteric ischemia, gastrointestinal perforation, obstruction. Surgical exploration is mandatory in hemodynamically unstable patients presenting with acute abdomen.