Article Text

Download PDFPDF
Value of initial radiological investigations in patients admitted to hospital with appendicitis, acute gallbladder disease or acute pancreatitis
  1. Aneel Bhangu1,
  2. Charlotte Richardson1,
  3. Hannah Winter2,
  4. Anthony Bleetman3
  1. 1Department of Surgery, Good Hope Hospital, Birmingham, UK
  2. 2Department of Surgery, Birmingham Heartlands Hospital, Birmingham, UK
  3. 3Department of Emergency Medicine, Good Hope and Birmingham Heartlands Hospitals, Heart of England Foundation Trust, Birmingham, UK
  1. Correspondence to Mr Aneel Bhangu, Department of Surgery, Good Hope Hospital, Rectory Road, Sutton Coldfield, Birmingham, B75 7RR, UK; aneelbhangu{at}


Objectives To determine the value of abdominal radiography (AXR) for investigating patients attending hospital with a first episode of appendicitis (requiring appendicectomy), acute gallbladder disease or acute pancreatitis, and to identify if early (within 18 h) ultrasound or CT scanning reduces the use of AXR.

Setting Two acute teaching hospitals during August–September 2008 and February–March 2009.

Participants Audit of 355 patients (179 patients (50%) who underwent appendicectomy, 128 (36%) admitted with acute gallbladder disease and 48 (14%) with acute pancreatitis).

Results AXR was performed in 53 patients (30%) who underwent appendicectomy, 73 (57%) with acute gallstone disease and 38 (78%) with acute pancreatitis. The useful abnormality pick-up rate was low; 9% (n=5), 5% (n=4) and 0% (n=0), respectively. When used, ultrasound confirmed the diagnosis in 84% (140/166) and CT scanning (either after AXR or as first line) in 97% (34/35). 42 patients underwent early ultrasound (n=27) or CT scanning (n=15), which together reduced the rate of AXR usage by 34% (14/42 early vs 107/159 delayed, p<0.001).

Conclusions AXR does not aid diagnosis of these conditions but is still performed. Early ultrasound or CT scanning reduces the use of AXR and are more sensitive; methods of providing these should be explored.

  • Abdominal radiograph
  • abdominal ultrasound scan
  • acute abdominal pain
  • appendicitis
  • gallstone disease
  • pancreatitis, abdomen
  • imaging, x-ray
  • ultrasound
  • trauma

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

  • Ethics approval This was a retrospective audit involving no patient contact. The audit protocol was approved and registered with the trust research and audit department.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

  • Primary survey
    Geoffrey Hughes