Abdominal Pain of Unknown Etiology I. James Sarfeh, MD, Albany, New York
Abdominal pain of unknown etiology remains an important medical and surgical problem. The results of diagnosis and therapy are imperfect and hospital readmission for the same condition is frequent [I 1. This is particularly true of adults; the complaints of children are of short duration, resulting in operation or discharge after observation with minimal diagnostic evaluation [Z]. This study was designed to determine if there are any criteria which can provide clues as to the eventual course of adult patients with abdominal pain of unknown etiology so that repeated hospitalizations for diagnostic evaluations and exploratory operations can be minimized. Material and Methods The charts of all patients discharged from Albany Medical Center Hospital with diagnosis of abdominal pain of unknown etiology in the four year period from 1968 to 1971 inclusive were reviewed. The following were excluded from this study: (1) patients less than sixteen years of age; (2) patients whose hospital stay was less than three days; (3) patients in whom a basic diagnostic evaluation (including intravenous pyelogram, cholecystogram, barium enema, and gastrointestinal series) was not done; and (4) patients admitted to the obstetric and gynecologic services. (The basis for this decision was that the nature of complaints in many of these patients unavoidably results in the tendency for many of them to receive diagnoses that cannot be substantiated to account for their pain.) From the hospital records seventy-six of 182 patients met the criteria for inclusion into the study, of whom twelve were lost to follow-up in that the current status of the.abdominal pain could not be ascertained, thus leaving sixty-four patients to be reported on herein. The distribution by sex and age of the twelve patients was similar to the group as a whole. Follow-up was done by inspection of hospital charts of patients who were readmitted, records of patients seen in the Emergency Room after discharge, and review of office records of attending and referring physicians in the fol-
From lheDepartment of Surgery, Albany Medical College. Albany, hew YC&. Reprint reqMsts should be addressed to I. James Sarfeh, MD, ME602 t%Parhent of Surgery, Albany Medical College, Albany, New York 12208.
22
low-up period. In those patients whose outcome was unclear, the physicians involved were interviewed. The minimal follow-up period was three years, and maximal seven years. Patients were classified as to: (1) sex; (2) age at the time of onset of abdominal complaints; and (3) duration of symptoms since the first episode of abdominal distress. The results after discharge were categorized as: (1) unimproved; (2) improved; or (3) subsequently diagnosed
(patients who after hospital discharge had laboratory, radiographic, or operative findings that allowed a diagnosis as to cause of abdominal pain). No attempt was made to categorize the nature of symptoms since the pain distribution of these patients failed to conform to specific patterns. The chi square method was used to evaluate statistical differences between various groups. Results (Table I) Sex. Of the sixty-four patients, 72 per cent were female and 28 per cent male. (Female to male ratio of all adult nonobstetric-gynecologic admissions is 1.3:1.) Of the females, 67 per cent were unimproved and 33 per cent were improved or subsequently diagnosed, as compared with 22 and 78 per cent, respectively, of the male group (p KO.05). Age. The number of patients in each group was fairly similar. There was a tendency for the younger age groups to remain free of symptoms after hospital discharge (in patients from 16 to 21 years old, 44 per cent remained unimproved, whereas 56 per cent were improved and none were subsequently diagnosed, in patients older than 60 years, ‘75per cent were unimproved, none were improved, and 25 per cent were subsequently diagnosed), but the differences were not statistically significant due to the smaller number of patients in each age category. Duration of Pain. When the duration of pain since onset was greater than fourteen days, 10 per cent of the patients were unimproved and 90 per cent were improved or subsequently diagnosed, as compared with 77 and 23 per cent, respectively, in those patients whose symptoms lasted more than ninety days (p CO.05).
The Amerkan
Journal ol Surgery
Abdominal
Sex and Duration of Pain. Of the females who had
symptoms for more than ninety days, 88 per cent remained symptomatic, whereas all females with duration of pain less than fourteen days were improved or had cause of pain subsequently diagnosed (p
Abdominal pain of unknown etiology remains an important medical and surgical problem. The results of diagnosis and therapy are imperfect and hospital readmission for the same condition is frequent [I 1. This is particularly true of adults; the complaints of children are of short duration, resulting in operation or discharge after observation with minimal diagnostic evaluation [Z]. This study was designed to determine if there are any criteria which can provide clues as to the eventual course of adult patients with abdominal pain of unknown etiology so that repeated hospitalizations for diagnostic evaluations and exploratory operations can be minimized. Material and Methods The charts of all patients discharged from Albany Medical Center Hospital with diagnosis of abdominal pain of unknown etiology in the four year period from 1968 to 1971 inclusive were reviewed. The following were excluded from this study: (1) patients less than sixteen years of age; (2) patients whose hospital stay was less than three days; (3) patients in whom a basic diagnostic evaluation (including intravenous pyelogram, cholecystogram, barium enema, and gastrointestinal series) was not done; and (4) patients admitted to the obstetric and gynecologic services. (The basis for this decision was that the nature of complaints in many of these patients unavoidably results in the tendency for many of them to receive diagnoses that cannot be substantiated to account for their pain.) From the hospital records seventy-six of 182 patients met the criteria for inclusion into the study, of whom twelve were lost to follow-up in that the current status of the.abdominal pain could not be ascertained, thus leaving sixty-four patients to be reported on herein. The distribution by sex and age of the twelve patients was similar to the group as a whole. Follow-up was done by inspection of hospital charts of patients who were readmitted, records of patients seen in the Emergency Room after discharge, and review of office records of attending and referring physicians in the fol-
From lheDepartment of Surgery, Albany Medical College. Albany, hew YC&. Reprint reqMsts should be addressed to I. James Sarfeh, MD, ME602 t%Parhent of Surgery, Albany Medical College, Albany, New York 12208.
22
low-up period. In those patients whose outcome was unclear, the physicians involved were interviewed. The minimal follow-up period was three years, and maximal seven years. Patients were classified as to: (1) sex; (2) age at the time of onset of abdominal complaints; and (3) duration of symptoms since the first episode of abdominal distress. The results after discharge were categorized as: (1) unimproved; (2) improved; or (3) subsequently diagnosed
(patients who after hospital discharge had laboratory, radiographic, or operative findings that allowed a diagnosis as to cause of abdominal pain). No attempt was made to categorize the nature of symptoms since the pain distribution of these patients failed to conform to specific patterns. The chi square method was used to evaluate statistical differences between various groups. Results (Table I) Sex. Of the sixty-four patients, 72 per cent were female and 28 per cent male. (Female to male ratio of all adult nonobstetric-gynecologic admissions is 1.3:1.) Of the females, 67 per cent were unimproved and 33 per cent were improved or subsequently diagnosed, as compared with 22 and 78 per cent, respectively, of the male group (p KO.05). Age. The number of patients in each group was fairly similar. There was a tendency for the younger age groups to remain free of symptoms after hospital discharge (in patients from 16 to 21 years old, 44 per cent remained unimproved, whereas 56 per cent were improved and none were subsequently diagnosed, in patients older than 60 years, ‘75per cent were unimproved, none were improved, and 25 per cent were subsequently diagnosed), but the differences were not statistically significant due to the smaller number of patients in each age category. Duration of Pain. When the duration of pain since onset was greater than fourteen days, 10 per cent of the patients were unimproved and 90 per cent were improved or subsequently diagnosed, as compared with 77 and 23 per cent, respectively, in those patients whose symptoms lasted more than ninety days (p CO.05).
The Amerkan
Journal ol Surgery
Abdominal
Sex and Duration of Pain. Of the females who had
symptoms for more than ninety days, 88 per cent remained symptomatic, whereas all females with duration of pain less than fourteen days were improved or had cause of pain subsequently diagnosed (p
