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## Complete Summary

#### GUIDELINE TITLE

Acute abdominal pain and fever or suspected abdominal abscess.

#### BIBLIOGRAPHIC SOURCE(S)

Rosen MP, Bree RL, Foley WD, Gay SB, Glick SN, Heiken JP, Huprich JE,
Levine MS, Ros PR, Shuman WP, Greene FL, Rockey DC, Expert Panel on
Gastrointestinal Imaging. Acute abdominal pain and fever or suspected
abdominal abscess. \[online publication\]. Reston (VA): American College
of Radiology (ACR); 2006. 7 p. \[56 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Saini S, Ralls PW, Balfe DM,
Bree RL, DiSantis DJ, Glick SN, Levine MS, Megibow AJ, Shuman WP, Greene
FL, Laine LA, Lillemoe K, Brown M, Berland L. Suspected abdominal
abscess. American College of Radiology. ACR Appropriateness Criteria.
Radiology 2000 Jun;215(Suppl):173-9.

The appropriateness criteria are reviewed annually and updated by the
panels as needed, depending on introduction of new and highly
significant scientific evidence.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Acute abdominal pain and fever

-   Abdominal abscess

**Note**: This guideline is arbitrarily limited to illnesses affecting
the region between the diaphragm and the upper pelvis and excludes both
renal and flank pathology.

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation

#### CLINICAL SPECIALTY

Emergency Medicine\
Family Practice\
Gastroenterology\
Internal Medicine\
Radiology

#### INTENDED USERS

Health Plans\
Hospitals\
Managed Care Organizations\
Physicians\
Utilization Management

#### GUIDELINE OBJECTIVE(S)

To evaluate the appropriateness of initial radiologic examinations for
patients with acute abdominal pain and fever and/or suspected abdominal
abscess

#### TARGET POPULATION

Patients, including pregnant and human immunodeficiency virus-positive
patients, with acute abdominal pain and fever or suspected abdominal
abscess

**Note**: Pediatric patients are not considered.

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Computed tomography (CT), abdomen and pelvis

    -   With contrast

    -   Without contrast

2.  Ultrasound (US), abdomen

3.  X-ray

    -   Abdomen

    -   Upper gastrointestinal (GI) with small bowel follow through
        (SBFT)

    -   Contrast enema, water soluble

4.  Nuclear medicine (NUC)

    -   Gallium scan

    -   White blood cell (WBC) scan

5.  Magnetic resonance imaging (MRI), abdomen and pelvis

    -   Without contrast

    -   With contrast

6.  Invasive (INV)

    -   Angiography

#### MAJOR OUTCOMES CONSIDERED

Utility of radiologic examinations in differential diagnosis

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The guideline developer performed literature searches of recent
peer-reviewed medical journals, and the major applicable articles were
identified and collected.

#### NUMBER OF SOURCE DOCUMENTS

The total number of source documents identified as the result of the
literature search is not known.

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Not Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not stated

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

One or two topic leaders within a panel assume the responsibility of
developing an evidence table for each clinical condition, based on
analysis of the current literature. These tables serve as a basis for
developing a narrative specific to each clinical condition.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus (Delphi)

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Since data available from existing scientific studies are usually
insufficient for meta-analysis, broad-based consensus techniques are
needed for reaching agreement in the formulation of the appropriateness
criteria. The American College of Radiology (ACR) Appropriateness
Criteria panels use a modified Delphi technique to arrive at consensus.
Serial surveys are conducted by distributing questionnaires to
consolidate expert opinions within each panel. These questionnaires are
distributed to the participants along with the evidence table and
narrative as developed by the topic leader(s). Questionnaires are
completed by the participants in their own professional setting without
influence of the other members. Voting is conducted using a scoring
system from 1-9, indicating the least to the most appropriate imaging
examination or therapeutic procedure. The survey results are collected,
tabulated in anonymous fashion, and redistributed after each round. A
maximum of three rounds is conducted and opinions are unified to the
highest degree possible. Eighty percent agreement is considered a
consensus. This modified Delphi technique enables individual, unbiased
expression, is economical, easy to understand, and relatively simple to
conduct.

If consensus cannot be reached by the Delphi technique, the panel is
convened and group consensus techniques are utilized. The strengths and
weaknesses of each test or procedure are discussed and consensus reached
whenever possible. If \"No consensus\" appears in the rating column,
reasons for this decision are added to the comment sections.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Criteria developed by the Expert Panels are reviewed by the American
College of Radiology (ACR) Committee on Appropriateness Criteria.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**ACR Appropriateness Criteria®**

**Clinical Condition: Acute Abdominal Pain and Fever or Suspected
Abdominal Abscess**

**Variant 1: Postoperative patient with fever.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  CT, abdomen and      8                    
  pelvis, with                             
  contrast                                 

  CT, abdomen and      7                    
  pelvis, without                          
  contrast                                 

  US, abdomen          6                    

  MRI, abdomen and     6                    
  pelvis, with                             
  contrast                                 

  X-ray, abdomen       5                    

  MRI, abdomen and     5                    
  pelvis, without                          
  contrast                                 

  X-ray, contrast      4                    
  enema, water soluble                     

  NUC, gallium scan    4                    

  X-ray, upper GI with 3                    
  small bowel follow                       
  through (SBFT)                           

  NUC, WBC scan        3                    

  INV, angiography     2                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 2: Postoperative patient with persistent fever and no abscess
seen on CT scan within the last 7 days.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  CT, abdomen and      8                    
  pelvis, with                             
  contrast                                 

  CT, abdomen and      6                    
  pelvis, without                          
  contrast                                 

  US, abdomen          6                    

  NUC, WBC scan        6                    

  X-ray, abdomen       5                    

  X-ray, upper GI with 5                    
  small bowel follow                       
  through (SBFT)                           

  NUC, gallium scan    5                    

  MRI, abdomen and     5                    
  pelvis, without                          
  contrast                                 

  MRI, abdomen and     5                    
  pelvis, with                             
  contrast                                 

  X-ray, contrast      4                    
  enema, water soluble                     

  INV, angiography     2                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 3: Patient presenting with fever, non-localizing abdominal
pain, and no recent operations.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  CT, abdomen and      8                    
  pelvis, with                             
  contrast                                 

  CT, abdomen and      6                    
  pelvis, without                          
  contrast                                 

  US, abdomen          6                    

  X-ray, abdomen       6                    

  X-ray, upper GI with 5                    
  small bowel follow                       
  through (SBFT)                           

  X-ray, contrast      5                    
  enema, water soluble                     

  NUC, gallium scan    5                    

  NUC, WBC scan        5                    

  MRI, abdomen and     5                    
  pelvis, without                          
  contrast                                 

  MRI, abdomen and     5                    
  pelvis, with                             
  contrast                                 

  INV, angiography     2                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 4: Pregnant patient.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  US, abdomen          8                    

  MRI, abdomen and     7                    
  pelvis, without                          
  contrast                                 

  MRI, abdomen and     7                    
  pelvis, with                             
  contrast                                 

  CT, abdomen and      5                   Only after other studies without
  pelvis, with                             ionizing radiation have been
  contrast                                 utilized.

  CT, abdomen and      5                    
  pelvis, without                          
  contrast                                 

  X-ray, abdomen       4                    

  X-ray, upper GI with 2                    
  small bowel follow                       
  through (SBFT)                           

  X-ray, contrast      2                    
  enema, water soluble                     

  NUC, gallium scan    2                    

  NUC, WBC scan        2                    

  INV, angiography     2                    

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

Acute abdominal pain with fever raises clinical suspicion of an
intra-abdominal abscess or other condition that may need immediate
surgical or medical attention. Infection or other inflammatory
conditions are the usual cause. In these circumstances, emergency
imaging is often employed, in conjunction with other clinical
information, to make a quick and accurate diagnosis. This is crucial, as
proper diagnosis facilitates expeditious and appropriate therapy, thus
improving patient outcome. This discussion is arbitrarily limited to
illnesses affecting the region between the diaphragm and the upper
pelvis and excludes both renal and flank pathology. Pediatric patients
are not considered.

The range of pathology that can produce abdominal pain and fever with or
without abscess is very broad. It includes pneumonia, hepatobiliary
disease, complicated pancreatic processes, gastrointestinal perforation
or inflammation, bowel obstruction or infarction, abscesses anywhere in
the abdomen, and tumor---among others. Of all patients who present to an
emergency room with abdominal pain, about one-third never have a
diagnosis established, one-third have appendicitis, and one-third have
some other documented pathology. In the \"other\" category, the most
common causes include (in order of frequency): acute cholecystitis,
small bowel obstruction, pancreatitis, renal colic, perforated peptic
ulcer, cancer, and diverticulitis. When fever is also present, the need
for quick, definitive diagnosis is considerably heightened.

A variety of clinical presentations occur in patients with acute
abdominal pain accompanied by fever. This review concentrates on the
evaluation of patients with acute diffuse abdominal pain, human
immunodeficiency virus (HIV)-positive patients with acute abdominal pain
and patients with suspected abdominal abscess. Other Appropriateness
Criteria® topics address acute right upper quadrant pain, acute right
lower quadrant pain, and acute left lower quadrant pain. Imaging
evaluation varies slightly among patients with different clinical
presentations. In general, CT is the most important modality in
evaluating patients with abdominal pain, more so in those with fever.
Two reports have found CT superior to clinical evaluation for finding
the cause of abdominal pain. CT was correct in 90%-95% of cases, while
clinical evaluation was correct in 60%-76% of cases. Additionally, the
use of CT in patients with acute abdominal pain increases the emergency
department clinician\'s level of certainty and reduces hospital
admissions by 24%. The presence of a white blood count (WBC) \>11.5 has
been correlated with a positive abdominal CT, and the combination of WBC
\>11.5, male sex, and age less than 25 years has been shown to correlate
with a diagnosis of appendicitis. Abdominal CT without the use of oral
or intravenous (IV) contrast has been advocated as an alternative to
abdominal radiographs for evaluating appendicitis; however, the use of
contrast agents greatly increases the spectrum of detectable pathology.

Acute diffuse abdominal pain with fever can be caused by conditions that
ordinarily instigate more localized pain. These conditions include
complicated appendicitis, complicated acute calculous or acalculous
cholecystitis, bile duct obstruction with infectious cholangitis,
hepatitis, hepatic abscess, pancreatitis with or without infection,
pyelonephritis or renal infarction, renal stones, omental infarction,
epiploic appendagitis, mesenteric adenitis, and diverticulitis. Other
conditions that typically present with diffuse abdominal pain and fever
include bowel obstruction, bowel ischemia or infarction, gut perforation
from ulcer or tumor, diffuse colitis, typhlitis and other
gastrointestinal infections, small bowel inflammatory disease, abdominal
abscess, intraperitoneal or retroperitoneal hemorrhage, and diffuse
malignancy. Less common cases of abdominal pain include tuberculous
peritonitis.

Again, radiographs may provide useful information about bowel gas
pattern or free air, but they offer no incremental information if CT is
performed. Sonography may be useful in selected conditions, including
cholecystitis, cholangitis, liver abscess, diverticulitis, appendicitis,
and small bowel inflammation, where it may be used to assess activity of
Crohn\'s disease. While US may be able to detect portions of an abscess
or malignancy (such as lymphoma), it is blind to many areas of the
abdomen, particularly in the presence of increased bowel gas or free
air. The shortcomings of US are partially offset by its lack of ionizing
radiation, particularly in younger patients. In women with pelvic
inflammatory disease (PID), pelvic US can be especially useful in
identifying the presence of a tubo-ovarian abscess (TOA). With CT of the
abdomen and pelvis in a young adult, there is a small risk of the
radiation causing a fatal cancer, which some believe may be as high as
one in 2,000 patients. MRI offers imaging without ionizing radiation and
has been shown to provide clinically useful information for rapid
diagnosis of the following gynecological emergencies: ovarian
hemorrhage, ectopic pregnancy, tumor rupture, torsion, hemorrhage,
infarction, and pelvic inflammatory disease.

In patients with high-grade bowel obstruction, CT sensitivity varies
from 86%-100%, with slightly lower sensitivity reported for low-grade
obstruction. In this regard, CT considerably outperforms the combination
of clinical evaluation and radiographs. CT also has the ability to
identify and localize the cause of obstruction in 73%-95% of cases.
Additionally, it can identify closed-loop obstruction (sensitivity 79%)
and associated strangulation (sensitivity 67%). For intestinal ischemia,
reported sensitivity of CT varies from 65%-86% based on findings of
vessel thrombosis, intramural or portal gas, and lack of bowel wall
enhancement. For intestinal infarction, CT (sensitivity 82%)
considerably outperforms radiography plus US (sensitivity 28%). In gut
perforation, while radiographs are sensitive to small volumes of free
air, CT is more sensitive to even smaller volumes and can detect
additional loculated air or air in the mesenteric root. Other CT
findings include extravasation of oral contrast, mesenteric edema, or
phlegmonous mass adjacent to a site of perforation.

In patients with Crohn\'s disease or inflammatory colitis, the presence
of fever raises the question of associated abscess or phlegmon, although
CT is the procedure of choice for the diagnosis of abscess, regardless
of cause. The accuracy of US in detecting abscess formation among
patients with known Crohn\'s disease has been reported to be to 86.9%
compared to 91.8% for CT. In addition, CT can show the extent of any
related fistulas or sinus tracts. However, the diagnostic accuracy of US
and barium studies in detecting internal fistulas has been reported to
be similar: 85.2% for US and 84.8% for barium studies. Pseudomembranous
colitis may have fever without abscess; CT findings are present in the
colon in 88% of cases. While technetium-99m labeled
hexamethylpropyleneamine oxime (Tc 99m HMPAO) white cell-labeled
scanning has a high sensitivity for inflammatory bowel disease (91%-98%)
and may have some role in diagnosing appendicitis in older patients, it
does not do as well as CT in detecting the complications of abscess and
fistula. Rarely, diffuse tumors such as lymphomas or metastases may
present with abdominal pain and fever; again, CT is the procedure of
choice due to its ability to assess well all node groups and organs.

**Acute Abdominal Pain with Fever in the HIV-Positive Patient**

Common causes of acute diffuse abdominal pain with fever in the
HIV-positive patient are more diverse than they are in other patients.
In addition to more usual conditions, typhlitis, intramural gut
hemorrhage, and small bowel or colonic perforation with associated
abscess may occur. The liver and biliary tree may be involved with
HIV-related cholangiopathy, hepatic abscesses, or hepatic bacillary
angiomatosis, a peliosis-like condition. The spleen is subject to focal
infarction or abscess. Gut mucosal disease may include GI tuberculosis,
ulcerating colitis cytomegalovirus (CMV), clostridium difficile,
histoplasmosis, candida, mycobacterium avium complex (MAC)-related
enteritis, and opportunistic bowel infection (cryptosporidiosis,
giardia, Isospora, and strongyloides). Tumors with adenopathy and bowel
involvement include Kaposi\'s sarcoma and lymphoma of gut, either of
which may lead to bowel obstruction, pneumatosis intestinalis,
perforation, or intussusception.

CT with oral, IV, and (frequently) rectal contrast is almost always the
procedure of choice in a HIV-positive patient with acute abdominal pain
and fever. Supplemental barium studies of the mucosa of the stomach,
small bowel, and colon may add additional information to that obtained
from CT, particularly when mucosal lesions are small and fine. If there
is any chance of gut perforation, barium should not be used.
Occasionally, US of the biliary tree and gallbladder may be useful in
evaluating HIV-related cholangiopathy. If CT is performed, radiographs
have little incremental value. The use of radionuclide scanning in this
subgroup has not been reported.

**Suspected Abdominal Abscess**

Patients suspected of having abdominal abscesses may present in a number
of ways: with fever, with diffuse or localized abdominal pain, or with a
history of a condition that may predispose to abdominal abscesses, such
as recent surgery and inflammatory bowel disease, pancreatitis, etc.
Imaging studies that have been used to detect abdominal abscesses
include radiographs (supine and upright, and occasionally decubitus
views); nuclear medicine studies such as gallium, indium, or technetium
tagged leukocytes studies; US; CT; and more recently MRI. Unfortunately,
much of the literature for radiography, gallium and indium leukocytes
scintigraphy, and CT scanning is more than a decade old. The current
literature has recently focused on the role of CT in percutaneous
drainage of abdominal abscesses. The implication is that CT scan is
already the primary means of making the diagnosis of abdominal abscess.
The implication is that CT scan is already the primary means of making
the diagnosis of abdominal abscess.

CT scanning has been shown to be the first and best test for diagnosing
of intra-abdominal abscess in patients who have recently had abdominal
surgery, and in patients with localizing signs for abscess. Among
intensive care unit (ICU) patients with sepsis of unknown origin, CT of
the torso revealed the source of sepsis in 5 of 38 patients, and CT of
the abdomen and pelvis revealed the source of sepsis in 7 of 45
patients. The CT scan can be very helpful in determining whether a
patient with pancreatitis has developed a pancreatic abscess and can
occasionally be useful in detecting abscess formation in patients with
diverticulitis or Crohn\'s disease. However, the sensitivity of
detecting abscesses in this latter group of patients is reduced compared
with the other categories mentioned above. Although CT scans can be
quite accurate in detecting abnormalities of the psoas, the
differentiation of psoas abscesses from other psoas lesions is difficult
when only imaging criteria are used.

US is often useful in specific cases, but when compared with CT
scanning, the results are usually of lower sensitivity and specificity.
This is especially true in bacterial infections of the kidney. Gallium
scanning and indium and technetium leukocyte scanning are often useful
when CT scan is negative or equivocal. Nuclear scintigraphy affords the
possibility of whole-body imaging and the detection of sites of
infection beyond the abdominal region. The literature on
technetium-labeled leukocytes suggests a very high sensitivity and
specificity for abdominal abscesses as well, although there are no
adequate recent comparisons with CT. Although gallium is excreted in the
GI tract, making it a poor choice for primary imaging of abdominal
abscesses among patients with persistent fever following colorectal
surgery, the diagnostic accuracy for GA-67 in detecting occult abscesses
has been reported to be as high as 91.2% (compared to diagnostic
accuracy of 97.1% for CT among the same patients). One study suggests
that MRI is an accurate examination for detecting abdominal abscesses.

There is little current information on radiography\'s role in detecting
abdominal abscesses. Some reports suggest that radiographs may be
useful, but this is far from proven.

Patients without previous surgery or with a low clinical suspicion of
abscess are effectively evaluated with CT, and may also be studied with
indium- or technetium-labeled leukocytes to search for infection or
inflammation.

**Abbreviations**

-   CT, computed tomography

-   GI, gastrointestinal

-   INV, invasive

-   MRI, magnetic resonance imaging

-   NUC, nuclear medicine

-   US, ultrasound

-   WBC, white blood cell

#### CLINICAL ALGORITHM(S)

Algorithms were not developed from criteria guidelines.

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The recommendations are based on analysis of the current literature and
expert panel consensus.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Selection of appropriate radiologic imaging procedures for evaluation of
patients with acute abdominal pain and fever or suspected abdominal
abscess

#### POTENTIAL HARMS

With computed tomography (CT) of the abdomen and pelvis in a young
adult, there is a small risk of the radiation causing a fatal cancer,
which some believe may be as high as one in 2,000 patients.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

An American College of Radiology (ACR) Committee on Appropriateness
Criteria and its expert panels have developed criteria for determining
appropriate imaging examinations for diagnosis and treatment of
specified medical condition(s). These criteria are intended to guide
radiologists, radiation oncologists, and referring physicians in making
decisions regarding radiologic imaging and treatment. Generally, the
complexity and severity of a patient\'s clinical condition should
dictate the selection of appropriate imaging procedures or treatments.
Only those exams generally used for evaluation of the patient\'s
condition are ranked. Other imaging studies necessary to evaluate other
co-existent diseases or other medical consequences of this condition are
not considered in this document. The availability of equipment or
personnel may influence the selection of appropriate imaging procedures
or treatments. Imaging techniques classified as investigational by the
U.S. Food and Drug Administration (FDA) have not been considered in
developing these criteria; however, study of new equipment and
applications should be encouraged. The ultimate decision regarding the
appropriateness of any specific radiologic examination or treatment must
be made by the referring physician and radiologist in light of all the
circumstances presented in an individual examination.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Personal Digital Assistant (PDA) Downloads

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Rosen MP, Bree RL, Foley WD, Gay SB, Glick SN, Heiken JP, Huprich JE,
Levine MS, Ros PR, Shuman WP, Greene FL, Rockey DC, Expert Panel on
Gastrointestinal Imaging. Acute abdominal pain and fever or suspected
abdominal abscess. \[online publication\]. Reston (VA): American College
of Radiology (ACR); 2006. 7 p. \[56 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1996 (revised 2006)

#### GUIDELINE DEVELOPER(S)

American College of Radiology - Medical Specialty Society

#### SOURCE(S) OF FUNDING

The American College of Radiology (ACR) provided the funding and the
resources for these ACR Appropriateness Criteria®.

#### GUIDELINE COMMITTEE

Committee on Appropriateness Criteria, Expert Panel on Gastrointestinal
Imaging

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Panel Members*: Max Paul Rosen, MD, MPH ; Robert L. Bree, MD, MHSA; W.
Dennis Foley, MD; Spencer B. Gay, MD; Seth N. Glick, MD; Jay P. Heiken,
MD; James E. Huprich, MD; Marc S. Levine, MD; Pablo R. Ros, MD, MPH;
William P. Shuman, MD; Frederick L. Greene, MD; Don C. Rockey, MD

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Saini S, Ralls PW, Balfe DM,
Bree RL, DiSantis DJ, Glick SN, Levine MS, Megibow AJ, Shuman WP, Greene
FL, Laine LA, Lillemoe K, Brown M, Berland L. Suspected abdominal
abscess. American College of Radiology. ACR Appropriateness Criteria.
Radiology 2000 Jun;215(Suppl):173-9.

The appropriateness criteria are reviewed annually and updated by the
panels as needed, depending on introduction of new and highly
significant scientific evidence.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[American College of Radiology (ACR) Web
site](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonGastrointestinalImaging/AcuteAbdominalPainandFeverorSuspectedAbdominalAbscessDoc1.aspx).

ACR Appropriateness Criteria® *Anytime*, *Anywhere*™ (PDA application).
Available from the [ACR Web
site](http://www.acr.org/SecondaryMainMenuCategories/ACRStore/FeaturedCategories/QualityandSafety/ac_pda.aspx).

Print copies: Available from the American College of Radiology, 1891
Preston White Drive, Reston, VA 20191. Telephone: (703) 648-8900.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   ACR Appropriateness Criteria®. Background and development. Reston
    (VA): American College of Radiology; 2 p. Electronic copies:
    Available in Portable Document Format (PDF) from the [American
    College of Radiology (ACR) Web
    site](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/background_dev.aspx).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on March 19, 2001. The information
was verified by the guideline developer on March 29, 2001. This NGC
summary was updated by ECRI on August 17, 2006.

#### COPYRIGHT STATEMENT

Instructions for downloading, use, and reproduction of the American
College of Radiology (ACR) Appropriateness Criteria® may be found on the
[ACR Web
site.](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/ACRAppropriatenessCriteriaTermsandConditionsDoc1.aspx)

### DISCLAIMER

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Date Modified: 11/3/2008