The Diagnostic Paradox in Acute Obstructive Abdomen: When Clinical Findings

• DOI: https://doi.org/10.22533/at.ed.159512503012

• Palavras-chave: Acute obstructive abdomen; Diagnostic Imaging; Clinical findings; Multidisciplinary approach; Artificial intelligence in radiology.

• Keywords: Acute obstructive abdomen; Diagnostic Imaging; Clinical findings; Multidisciplinary approach; Artificial intelligence in radiology.

• Abstract: INTRODUCTION Acute obstructive abdomen presents significant diagnostic challenges due to frequent discrepancies between clinical findings and imaging results. While clinical examination provides initial insights, it often lacks the precision needed for definitive diagnosis, necessitating the use of advanced imaging modalities such as computed tomography. Despite its high sensitivity and specificity, imaging can yield false positives and negatives, particularly in complex cases like transient obstructions, postoperative changes, or conditions mimicking obstruction. These challenges underscore the need for a comprehensive diagnostic approach integrating clinical, imaging, and patient-specific factors. OBJETIVE To explore the diagnostic paradox in acute obstructive abdomen, focusing on the discrepancies between clinical findings and imaging results and their implications for patient outcomes. METHODS This is a narrative review which included studies in the MEDLINE – PubMed (National Library of Medicine, National Institutes of Health), COCHRANE, EMBASE and Google Scholar databases, using as descriptors: “Acute obstructive abdomen” OR “Diagnostic Imaging” OR “Clinical findings” OR “Multidisciplinary approach” OR “Artificial intelligence in radiology” in the last 5 years. RESULTS AND DISCUSSION The results highlight the importance of computed tomography as the gold standard, alongside the emerging role of contrast-enhanced imaging and point-of-care ultrasound in improving diagnostic precision. False-negative results due to transient or dynamic pathologies remain a significant concern, emphasizing the utility of repeat imaging in unresolved cases. Multidisciplinary collaboration involving surgeons, radiologists, and other specialists proves essential in interpreting discordant findings and guiding patient management. Advances in artificial intelligence and dynamic imaging techniques offer additional tools to refine diagnosis, although their implementation requires careful consideration of ethical and practical limitations. CONCLUSION A balanced, multidisciplinary approach is critical to resolving the diagnostic paradox in acute obstructive abdomen. Leveraging technological advancements while emphasizing clinical acumen can improve diagnostic accuracy, reduce errors, and optimize patient outcomes. Future research should focus on refining diagnostic algorithms, enhancing clinician education, and incorporating innovative technologies to bridge the gap between clinical and imaging findings.