Karın Ağrısında Görüntüleme İlkeleri: Direkt Radyografi (X-Ray)
Özet
Akut karın ağrısı, acil tıp pratiğinde ve genel cerrahi polikliniklerinde karşılaşılan en sık ve karmaşık klinik tablolardan birini oluşturmaktadır. Acil servis başvurularının önemli bir kısmını oluşturan bu şikayet, basit dispeptik yakınmalardan hayatı tehdit eden visseral perforasyonlara veya iskemik felaketlere kadar uzanan geniş bir etiyolojik spektrumu kapsar. Tanısal süreçte, anamnez ve fizik muayenenin vazgeçilmez yerinin yanı sıra, radyolojik görüntüleme yöntemleri klinik karar verme mekanizmasının merkezine yerleşmiştir. Tarihsel olarak "akut karın serisi" (ayakta direkt karın, yatarak direkt karın ve akciğer grafisi) şeklinde uygulanan direkt karın radyografisi (Abdominal X-Ray - AXR), günümüzde bilgisayarlı tomografinin (BT) teknolojik hakimiyeti ve kanıta dayalı tıp verilerinin ışığında ciddi bir sorgulama ve yeniden konumlandırma sürecinden geçmektedir.
Acute abdominal pain is one of the most common and complex clinical presentations encountered in emergency medicine practice and general surgery outpatient clinics. This complaint, which constitutes a significant portion of emergency department visits, encompasses a broad etiological spectrum ranging from simple dyspeptic complaints to life-threatening visceral perforations or ischemic catastrophes. In the diagnostic process, in addition to the indispensable role of medical history and physical examination, radiological imaging methods have become central to the clinical decision-making mechanism. Historically performed as the “acute abdomen series” (standing abdominal X-ray, supine abdominal X-ray, and chest X-ray), direct abdominal radiography (Abdominal X-Ray - AXR) is currently undergoing a process of serious questioning and repositioning in light of the technological dominance of computed tomography (CT) and evidence-based medicine data.
Referanslar
Tintinalli JE, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York: McGraw-Hill Education; 2020.
Gans SL, Stoker J, Boermeester MA. Plain abdominal radiography in acute abdominal pain; past, present, and future. Int J Gen Med. 2012;5:525-33.
Smith JE, Hall EJ. The use of plain abdominal x rays in the emergency department. Emerg Med J. 2009;26(3):160-3.
American College of Radiology. ACR Appropriateness Criteria® Acute Abdominal Pain. Available at: acsearch.acr.org. Accessed 2025.
The Royal College of Radiologists. iRefer Guidelines: Making the best use of clinical radiology. London: RCR; 2017.
Bontrager KL, Lampignano JP. Textbook of Radiographic Positioning and Related Anatomy. 9th ed. St. Louis: Elsevier; 2018.
Long BW, Rollins JH, Smith BJ. Merrill's Atlas of Radiographic Positioning and Procedures. 14th ed. St. Louis: Elsevier; 2019.
Fleischmann D. Radiation Dose & Risk. Stanford University School of Medicine; 2012. Available from: https://med.stanford.edu
Chaparian A, Aghabagheri M. Fetal radiation doses and subsequent risks from X-ray examinations: Should we be concerned? Iran J Reprod Med. 2013;11(11):899–904.
International Commission on Radiological Protection. Pregnancy and medical radiation. Ann ICRP. 2000;30(1):iii-43.
Maglinte DD, Reyes BL, Harmon BH, et al. Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction. Am J Roentgenol. 1996;167(6):1451–1455.
Choi JS, Lim JS, Kim H, et al. Colonic pseudoobstruction: CT findings. Am J Roentgenol. 2008;190(6):1521–1526.
Rigler LG. Spontaneous pneumoperitoneum: a roentgenologic sign found in the supine position. Radiology. 1941;37:604-9.
Bourakkadi Idrissi M, Dkhissi Y. Pneumoperitoneum and Chilaiditi syndrome: navigating a diagnostic conundrum. J Surg Case Rep. 2024;2024(2):rjae056.
Jalan KN, Sircus W, Card WI, et al. Toxic dilatation of colon (toxic megacolon): etiology, treatment and prognosis in 42 patients. Medicine (Baltimore). 1969;48(3):229–250.
Ripollés T, Miguel-Dasit A, Errando J, et al. Gallstone ileus: increased diagnostic sensitivity by combining plain film and ultrasound. Abdominal Imaging. 2004;29(1):111–115.
Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. Journal of Pediatric Gastroenterology and Nutrition. 2015;60(4):562–574.
del-Pozo G, Albajara A, Lorente J, et al. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics. 1999;19(2):299–319.
Berger MY, Tabbers MM, Koppeschaar HP, et al. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. Journal of Pediatrics. 2012;161(1):44–50.
Referanslar
Tintinalli JE, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York: McGraw-Hill Education; 2020.
Gans SL, Stoker J, Boermeester MA. Plain abdominal radiography in acute abdominal pain; past, present, and future. Int J Gen Med. 2012;5:525-33.
Smith JE, Hall EJ. The use of plain abdominal x rays in the emergency department. Emerg Med J. 2009;26(3):160-3.
American College of Radiology. ACR Appropriateness Criteria® Acute Abdominal Pain. Available at: acsearch.acr.org. Accessed 2025.
The Royal College of Radiologists. iRefer Guidelines: Making the best use of clinical radiology. London: RCR; 2017.
Bontrager KL, Lampignano JP. Textbook of Radiographic Positioning and Related Anatomy. 9th ed. St. Louis: Elsevier; 2018.
Long BW, Rollins JH, Smith BJ. Merrill's Atlas of Radiographic Positioning and Procedures. 14th ed. St. Louis: Elsevier; 2019.
Fleischmann D. Radiation Dose & Risk. Stanford University School of Medicine; 2012. Available from: https://med.stanford.edu
Chaparian A, Aghabagheri M. Fetal radiation doses and subsequent risks from X-ray examinations: Should we be concerned? Iran J Reprod Med. 2013;11(11):899–904.
International Commission on Radiological Protection. Pregnancy and medical radiation. Ann ICRP. 2000;30(1):iii-43.
Maglinte DD, Reyes BL, Harmon BH, et al. Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction. Am J Roentgenol. 1996;167(6):1451–1455.
Choi JS, Lim JS, Kim H, et al. Colonic pseudoobstruction: CT findings. Am J Roentgenol. 2008;190(6):1521–1526.
Rigler LG. Spontaneous pneumoperitoneum: a roentgenologic sign found in the supine position. Radiology. 1941;37:604-9.
Bourakkadi Idrissi M, Dkhissi Y. Pneumoperitoneum and Chilaiditi syndrome: navigating a diagnostic conundrum. J Surg Case Rep. 2024;2024(2):rjae056.
Jalan KN, Sircus W, Card WI, et al. Toxic dilatation of colon (toxic megacolon): etiology, treatment and prognosis in 42 patients. Medicine (Baltimore). 1969;48(3):229–250.
Ripollés T, Miguel-Dasit A, Errando J, et al. Gallstone ileus: increased diagnostic sensitivity by combining plain film and ultrasound. Abdominal Imaging. 2004;29(1):111–115.
Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. Journal of Pediatric Gastroenterology and Nutrition. 2015;60(4):562–574.
del-Pozo G, Albajara A, Lorente J, et al. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics. 1999;19(2):299–319.
Berger MY, Tabbers MM, Koppeschaar HP, et al. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. Journal of Pediatrics. 2012;161(1):44–50.
