 I'm Dr. Deep Singh Shabra from Vajman Mohave Medical College in Sardarjung Hospital. The topic of my paper is efficacy of anxiety abdomen in evaluation of non-traumatic acute abdomen. Non-traumatic acute abdomen can be due to a variety of causes with vitreining etiology which can either be traumatic or non-traumatic. In the case of non-traumatic acute abdomen, the cause can either be life threatening surgical emergency or benign self-limiting condition which responds to conservative medical management, imaging particularly computer tomography has a central role in diagnosing the etiology of acute abdomen. The use of CT has increased and improved over the over the last three decades. Traditionally, the use of intravenous or enteric contrast was necessary to overcome the motion, artificial respiration and test analysis. But with the advent of multi-temporal and helical CT scanners, the utility of contrast medium for image quality has become uncertain. Moreover, administration of contrast often requires normal blood, urine and creatinine levels which we might not be able to obtain readily in the emergency department. Or concurrent metabolic and renal functional arrangements in these patients may hamper the administration of contrast. Hence the aim of this study was to assess the efficacy of non-contrast CT scan of abdomen and pelvis in evaluating the patients coming to the emergency department with a non-traumatic acute abdominal pain. It also simultaneously aimed to study the role of conventional radiography in ultrasound in these patients. As a part of the study, 60 patients over 12 years of age presenting with non-traumatic acute abdominal pain of less than 72 hours in onset were included in the study. The patients with diagnosed renal calculus or acute volleys status, pregnant patients and patients with a BMI of less than 18.5 kg per meter square but also suited from the study. In the included patients playing radiography ultrasound followed by anxiety abdomen were performed in all the patients. CT was performed only when any extra information regarding the pathology diagnosis was required or no definitive diagnosis could be made on NCCT after obtaining normal blood unit creatinine levels. The patients were then followed up for the clinical and surgical outcome. The results showed that the conventional radiography showed the least concordance with the final diagnosis providing the final diagnosis only 9 out of the 60 cases while NCCT had the maximum substantial agreement with the final diagnosis providing final diagnosis in 46 out of 60 cases with a correlation coefficient of 0.74. While in the case of ultrasound and intermediate concordance with the with moderate agreement with the final diagnosis was found with the correlation coefficient of 0.34. CT was performed in 36 out of the 60 cases while it altered final diagnosis only in 11 cases. The overall sensitivity and accuracy of NCCT in acute and non-traumatic acute abdomen was found to be 81 and 82% respectively. In our study the main causes of acute abdomen were subacute industrial obstruction which was due to bowel structure in 12 cases while in 5 cases it was diagnosis, adhesives, subacute industrial obstruction. 9 cases of acute appendicitis and acute pancreatitis each were seen, 5 cases of perforation peritonitis were seen, 3 cases of acute gastritis, colitis and emphasmatitis, polynephritis and interception were seen, and 4 cases of sigmar valvular were seen. Other cases included acute diverticulitis, emphasmatitis, chastitis, sealed ileal perforation and uterine rupture. NCCT abdomen provided the final diagnosis in 46 out of the 60 cases that is in 76.6% of the cases. In the case of acute appendicitis all the 9 cases 3 of which were misdrawn ultrasound were also detected on NCCT which is in concordance to previous studies which have found similar high sensitivity ranging from 90 to 90% to 98.5% in detection of acute appendicitis. Now in the case of subacute industrial obstruction there were 17 cases of scion in our study out of which 12 were found due to bowel structure. Out of these 12 cases 9 cases could be diagnosed on NCCT itself but distal ileum being the most common set of the structure. Previous studies have demonstrated a higher sensitivity of NCCT in detection of the site of mechanical obstruction and the transition point of the structure. Lower sensitivity as compared to those studies is seen in our study because of the limited number of cases of bowel obstruction in our study. In the case of perforation peritonitis pneumoperitonium was detected in all the 5 cases. Moreover in 3 out of 5 cases we could also detect the site of perforation. This was mainly done by studying the concentration of extra luminal air bubbles in particular locations. For example in the case of pre-pilotic perforation the air was concentrated mainly in the perihepatic perigastric and the paradiodinal spaces. While in the case of distal ileum perforation was mainly seen in the region of distal ileum loops and in the pelvis. Previous studies have also shown that in addition to concentration of extra luminal air bubbles focal defect in bowel wall and areas of segmental bowel wall thickening are important predictors of determining the site of perforation. In the case of collocolic interception was seen in the case of collocolic interception Lycoma was seen as the lead point. All the 3 cases of emphysematos pyronephritis were successfully diagnosed and graded based on NCCT findings. NCCT was found to be clearly superior than X-ray and ultrasound abdomen in detection, grading and management of emphysematos pyronephritis. In the case of sigmat volvulus, the 4 cases of sigmat volvulus were seen in our study. All the 4 cases showed the characteristic whirl sign on the left of the midline on non-contrast scans. The overall sensitivity of NCCT in our study was calculated to be 81%. Previous studies by Lamarie Setal have found it to be 89% sensitive. Slightly lower sensitivity was seen in our study due to the limited sample size. NCCT was performed in 36 out of the 60 cases, while it altered the final diagnosis only in 11 cases. In 5 cases of adhesus subacuridin disanal obstruction, it ruled out the presence of any kind of structure. While in the case of active diverticulitis, definitive diagnosis could be made only after administration of intravenous and rectal contrast. These are some representative cases of our study. This is the case of 70-year-old female who presented with complaints of diffuse abdominal pain, vomiting and obstetrician for 24 hours. On non-contrast scans, the characteristic target configuration of bowel could be seen in the pelvis, with hypotenuating misentry in between. The axial reconstruction shows the telescoping of the proximal allele loops into the distal, with normal bowel well enhancement seen on the contrast enhanced scan. The intraoperative finding revealed allele into seception, with the dark pink color into septum and the light pink color into sepsia. The second case was that of a 50-year-old female who was an uncontrolled type of diabetes malitis patient. There were areas of motley seen in the region of urinary bladder, suggestive of air. On ultrasound of the pelvis, the urinary bladder revealed cogenic contents without any internal vascularity within, with interspersed areas of reverberation artifacts seen within the ecogenic area and subjected to the urinary bladder wall. So, non-contrast CT scan demonstrated gas fluid level within the urinary bladder, along with the contents of blood attenuation seen within the urinary bladder lumen and air focus adjacent to the urinary bladder wall. A diagnosis of emphysematism status was established and the patient was managed with insulin for glycemic control and intravenous antibiotics to control the infection. The second case was that of a 72-year-old male who presented with acute onset abdominal pain and features of obstipation and vomiting. The x-ray revealed the characteristic coffee bean configuration of the large bubble loop with non-visualization of the rectal gas. The non-contrast scan revealed the characteristic twisting of the misentry and the characteristic world sign. Further on the contrast scan, there was visualization of the vascular pedicle without any bubble wall hypo enhancement. Hence, the diagnosis of sigmoid volules with upstream intercell obstruction was made, which correlated with the surgical intraoperative fineness, which revealed massively dilated and twisted sigmoid colon. The fourth case was that of a 73-year-old female who presented with features of intercell obstruction for 48 hours on supine abdominal radiograph, a concentric fat density. A concentric fat density was seen in the abdominal radiograph on the left of the midline while on the erect abdominal radiograph, dilated bubble loops with air fluid devils were seen on non-contrast scans, axial and coronal images. There was telescoping of ascending colon into the transverse colon with a well-defined lesion of fat attenuation acting as a lead point, a diagnosis of colobolic interception with Lycoma as lead point, and upstream intercell obstruction was made. The patient underwent expedited laparotomy with right hemicolectomy and heliopoic anastomosis. The fifth case is that of a 52-year-old female who presented with left flank pain and tenderness for 48 hours. She had history of type 2 diabetes mellitus, which was controlled on all hypoglycemic agents. The entity, axial and coronal deformations are shown, which reveals and grossly enlarged and bulky left kidney with air within the pelvic lesion system, as well as within the perinephric and the perineal space, giving a diagnosis of class 3B of emphysematis pilonastritis. Final clinical diagnosis of type 2 diabetes mellitus with emphysematis pilonastritis was made. The patient underwent percutaneous catheter drainage and the fluoroscopic guidance with intravenous antibiotic therapy. Hence it can be concluded that non-contrast scans provide pertinent information regarding etiology of acute abdomen, contributing in patient management and hence can help in proper sorting triage of the patients and streamlined flow of patients in the emergency department with substantial economic advantage. Thank you for your patience listening.