Incidental Findings during Abdominal Surgery Clinical Significance and Ethical Consideration: A Systematic Review

Abstract

Background: Incidental findings (IFs) during abdominal surgery are unanticipated pathological or anatomical abnormalities discovered while operating for unrelated indications. Their detection presents both clinical management challenges and ethical dilemmas regarding disclosure, treatment, and patient consent. Objective: To systematically review the literature on the clinical significance and ethical considerations of incidental findings encountered during abdominal surgery. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library from July 2024 to August 2025. Eligible studies included original research, systematic reviews, and case series addressing the prevalence, types, clinical outcomes, and ethical implications of IFs during abdominal surgery. Data extraction and quality assessment were performed independently by two reviewers. Results: A total of 23 studies were included. The most commonly reported incidental findings were benign tumors, metastatic lesions, congenital anomalies, and organ-specific pathologies. Clinically significant IFs altered surgical management in a substantial proportion of cases, influencing both intraoperative decisions and long-term outcomes. Ethical challenges primarily revolved around informed consent, the extent of surgical intervention without prior patient approval, and disclosure of unexpected but clinically relevant conditions. Conclusion: Incidental findings during abdominal surgery are relatively common and may carry important clinical consequences. Surgeons must balance immediate management with ethical obligations of autonomy, beneficence, and informed consent. Developing standardized guidelines for the identification, management, and disclosure of IFs is crucial to optimize patient outcomes and uphold ethical practice.