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An “acute abdomen” denotes any sudden, spontaneous, nontraumatic, severe abdominal pain, typically of less than 24 hours duration. The acute abdomen requires rapid and specific diagnosis as several etiologies demand urgent operative intervention. Because there is frequently a progressive underlying intra-abdominal disorder, undue delay in diagnosis and treatment may adversely affect outcome.

The approach to a patient with an acute abdomen must be orderly and thorough. An acute abdomen should be suspected even in a patient with only mild or atypical presentations. Increasingly, certain patient populations present with atypical complaints, including the immunocompromised, elderly and gastric bypass patients. The history and physical examination often suggest the probable cause, allow formation of a differential diagnosis, and guide the choice of initial diagnostic studies. The clinician must then decide if in-hospital observation is warranted, if additional tests are needed, if early operation is indicated, or if nonoperative treatment would be more suitable.

All clinicians should be familiar with the presenting pattern of the most common causes of an acute abdomen (Table 21–1) and their atypical presentations in certain patient populations. Moreover, they should be familiar with regional specific disease patterns. While the most common cause of abdominal pain in patients presenting to the emergency department is nonspecific discomfort, missing treatable causes of abdominal pain can be disastrous for the patient.

Table 21–1.Common causes of the acute abdomen.1


Abdominal Pain

History taking by an experienced physician is key to focusing the evaluation of a patient with an acute abdomen. Taking a patient history is an active process whereby a large number of diagnostic possibilities are considered in order to systematically eliminate less likely conditions.

Pain is the most common and predominant presenting feature of an acute abdomen. Careful consideration of the location, severity, ...

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