The accuracy of the preoperative diagnosis in women undergoing emergent gynecological laparoscopy for acute abdominal pain

Objectives: To analyze the accuracy of the working diagnosis in emergent laparoscopies and identify variables associated with an accurate or faulty preoperative diagnosis. Methods: A retrospective cohort study including 217 consecutive women who underwent emergent laparoscopy for acute abdominal pain in 2000-2007. Each case was designated a preoperative-postoperative diagnostic match or mismatch by file review. The agreement between the clinical and preoperative ultrasound findings was analyzed according to the circumstances of imaging tests (Dopplerultrasound examination performed by a specialist or ultrasound performed by the on-call physician without Doppler examination). Results: On multivariate logistic stepwise regression analysis, the significant independent variables for prediction of preoperative-postoperative diagnostic match (n = 63, 29%) were pregnant state, preoperative clinicalultrasound match, and duration of symptoms. The circumstances of imaging tests were not a significant predictor for accurate preoperative diagnosis. Conclusions: In this retrospective analysis, Dopplerultrasound examination performed by a specialist was not associated with higher accuracy of the preoperative diagnosis in women undergoing emergent laparoscopy for acute abdominal pain. These data should be further validated in future prospective cohorts. Summary Doppler-ultrasound examination performed by a specialist does not add to the accuracy of the preoperative diagnosis in women undergoing emergent gynecological laparoscopy for acute abdominal pain.