Radiography demonstrates low overall sensitivity in the detection of colitidies and enteritidies, and even low-dose CT demonstrates superior diagnostic yield in comparison with abdominal radiography [16]. Many authors suggest that they have a limited role in the evaluation of nontraumatic abdominal pain in adults [17-22]. Fluoroscopy Contrast Enema No current literature supports the use of contrast enema for evaluating patients with nontraumatic abdominal pain and fever in the absence of recent surgery. Fluoroscopy Upper GI with SBFT No current literature supports the use of an upper GI series with small bowel follow-through (SBFT) for evaluating patients with abdominal pain and fever in the absence of recent surgery. CT Abdomen and Pelvis With a generally broad differential and need for fast imaging because of clinical acuity, CT is a preferred imaging option [23]. CT can be performed without and/or with intravenous (IV) contrast and with or without positive oral contrast. Most commonly, in the setting of nonlocalized, nontraumatic abdominal pain, a routine CT of the abdomen and pelvis is performed with IV contrast and a single postcontrast phase. In this setting, precontrast and postcontrast images are not required for diagnosis. Abdominal CT without the use of oral or IV contrast has been advocated as an alternative to abdominal radiographs for evaluating appendicitis [17,24]. However, the use of IV contrast increases the spectrum of detectable pathology in patients with nonlocalized pain [25,26]. Many institutions do not routinely use oral contrast because of the associated delay in scan acquisition and departmental throughput balanced against questionable diagnostic advantage [27-30]. Contraindications are not considered in the appropriateness assessment.
Acute Nonlocalized Abdominal Pain. Radiography demonstrates low overall sensitivity in the detection of colitidies and enteritidies, and even low-dose CT demonstrates superior diagnostic yield in comparison with abdominal radiography [16]. Many authors suggest that they have a limited role in the evaluation of nontraumatic abdominal pain in adults [17-22]. Fluoroscopy Contrast Enema No current literature supports the use of contrast enema for evaluating patients with nontraumatic abdominal pain and fever in the absence of recent surgery. Fluoroscopy Upper GI with SBFT No current literature supports the use of an upper GI series with small bowel follow-through (SBFT) for evaluating patients with abdominal pain and fever in the absence of recent surgery. CT Abdomen and Pelvis With a generally broad differential and need for fast imaging because of clinical acuity, CT is a preferred imaging option [23]. CT can be performed without and/or with intravenous (IV) contrast and with or without positive oral contrast. Most commonly, in the setting of nonlocalized, nontraumatic abdominal pain, a routine CT of the abdomen and pelvis is performed with IV contrast and a single postcontrast phase. In this setting, precontrast and postcontrast images are not required for diagnosis. Abdominal CT without the use of oral or IV contrast has been advocated as an alternative to abdominal radiographs for evaluating appendicitis [17,24]. However, the use of IV contrast increases the spectrum of detectable pathology in patients with nonlocalized pain [25,26]. Many institutions do not routinely use oral contrast because of the associated delay in scan acquisition and departmental throughput balanced against questionable diagnostic advantage [27-30]. Contraindications are not considered in the appropriateness assessment.