Asahi K. Retrospective analysis of computed tomography examinations in patients with lower abdominal pain: A single-center experience. World J Radiol 2025; 17(6): 105632 [DOI: 10.4329/wjr.v17.i6.105632]
Corresponding Author of This Article
Kouichi Asahi, MD, PhD, Assistant Professor, Department of General Medicine and Radiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Saitama 343-8555, Japan. kouichi81555@yahoo.co.jp
Research Domain of This Article
Imaging Science & Photographic Technology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Jun 28, 2025; 17(6): 105632 Published online Jun 28, 2025. doi: 10.4329/wjr.v17.i6.105632
Retrospective analysis of computed tomography examinations in patients with lower abdominal pain: A single-center experience
Kouichi Asahi
Kouichi Asahi, Department of General Medicine and Radiology, Dokkyo Medical University Saitama Medical Center, Saitama 343-8555, Japan
Kouichi Asahi, Kohokuekimae Ohisama Clinic, Internal Medicine and Pediatrics, Tokyo 123-0872, Japan
Author contributions: Asahi K designed the study, performed data collection and analysis, reviewed radiological images, drafted the manuscript, critically revised the manuscript for intellectual content, and approved the final manuscript.
Institutional review board statement: This study was retrospective in nature; thus, Institutional Review Board approval was not required.
Informed consent statement: Informed consent was waived due to the retrospective nature of the study, the absence of any identifiable patient information, and the use of routine diagnostic imaging data.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Data sharing statement: The dataset analyzed during the current study is available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kouichi Asahi, MD, PhD, Assistant Professor, Department of General Medicine and Radiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Saitama 343-8555, Japan. kouichi81555@yahoo.co.jp
Received: February 10, 2025 Revised: March 30, 2025 Accepted: May 21, 2025 Published online: June 28, 2025 Processing time: 138 Days and 3.8 Hours
Abstract
BACKGROUND
Lower abdominal pain presents as a common complaint with diverse etiologies ranging from benign conditions to surgical emergencies. Computed tomography (CT) imaging has become instrumental in accurate diagnosis and management planning, though clinicians must carefully balance its benefits against radiation exposure concerns and resource allocation constraints.
AIM
To comprehensively evaluate the diagnostic accuracy, utility and clinical implications of CT in patients with acute lower abdominal pain, emphasizing rare anatomical variations, pregnancy-related issues, and practical limitations of other imaging modalities in emergency settings in Japan.
METHODS
This retrospective review included 230 patients who underwent CT scans for acute lower abdominal pain at Juntendo University Shizuoka Hospital throughout 2014. CT findings were systematically correlated with the final clinical diagnoses. Cases with diagnostic uncertain underwent independent reviewed by two experienced radiologists. The CT protocols included portal venous-phase imaging with selective arterial-phase acquisition when clinically indicated.
RESULTS
Idiopathic pain was the most common diagnosis (104 cases, 45.2%), followed by appendicitis (46 cases, 20.0%) and diverticulitis (27 cases, 11.7%). Right lower quadrant pain predominantly revealed appendicitis (20.2%), whereas left lower quadrant pain frequently indicated diverticulitis (12.1%). Nonspecific pain cases have diverse etiologies. Rare conditions included situs inversus (one case) and intestinal malrotation (one case). Pregnancy-related diagnoses included acute appendicitis and uterine fibroid degeneration.
CONCLUSION
CT significantly aids in the diagnosis of lower abdominal pain, especially given limited access to ultrasonography and MRI during emergency hours in Japan. Awareness of the anatomical variations and pregnancy-related constraints is crucial. Diagnosis-specific protocols for CT based on pain location can optimize clinical management and resource utilization.
Core Tip: This study highlights computed tomography (CT) as the primary imaging modality for diagnosing acute lower abdominal pain, especially in emergency settings with limited availability of ultrasonography and magnetic resonance imaging. The results emphasize the diagnostic importance of recognizing rare anatomical variations (situs inversus and intestinal malrotation) and pregnancy-related conditions, underlining the necessity of tailored CT protocols based on pain localization. Given Japan’s practical constraints, including limited after-hours ultrasonography and magnetic resonance imaging access, our findings advocate for optimized, evidence-based CT imaging protocols to enhance diagnostic accuracy, patient safety, and efficient resource utilization.
