The Use of Computed Tomography in Non-Traumatic Acute Abdomen Cases: Clinical Necessity, Artificial Intelligence and Ethical Limits

Aim: This study aims to evaluate the necessity and limitations of computed tomography (CT) in non-traumatic acute abdomen cases, focusing on clinical indications, potential complications, and the ethical implications of overuse in vulnerable patient groups. Material And Method: This theoretical review is based on current literature evaluating the role of contrast-enhanced CT in diagnosing non-traumatic acute abdominal conditions. Particular emphasis is placed on patient risk stratification, contrast-induced nephropathy, radiation exposure, and the integration of artificial intelligence (AI) in radiological assessment. Results: CT remains a cornerstone in diagnosing conditions such as acute appendicitis, diverticulitis, epiploic appendagitis, omental infarction, and mesenteric ischemia. However, its application in elderly and comorbid patients carries risks of contrast-induced nephropathy. Recent studies show that implementing hydration protocols and risk-based selection criteria can mitigate such complications. Moreover, AI-supported imaging has shown promise in improving diagnostic accuracy and reducing unnecessary scans, although technical and ethical limitations persist. Discussion: The increasing reliance on CT in emergency departments has led to a “CT reflex,” where imaging is often ordered preemptively without adequate clinical justification. While CT can improve diagnostic confidence, especially in atypical presentations, indiscriminate use contradicts ethical principles, particularly the tenet of primum non nocere. Emerging AI technologies may support decision-making, yet cannot fully replace clinical judgment, especially in complex or high-risk populations. Conclusion: The use of CT in non-traumatic acute abdomen should be patient-centered, clinically justified, and ethically responsible. Alternatives such as ultrasonography should be prioritized when appropriate, and preventive measures must be taken to minimize complications in high-risk patients. CT should remain an essential, but not automatic, tool in emergency abdominal imaging.