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INTRODUCTION

An “acute abdomen” denotes any sudden, spontaneous, nontraumatic, severe abdominal pain, typically of less than 24 hours in duration. The acute abdomen requires rapid and specific diagnosis because 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. Therefore, understanding the clinical presentation, associated laboratory and diagnostic imaging findings, and various facets of preoperative evaluation of acute abdomen is essential.

The approach to a patient with an acute abdomen must be systematic and thorough yet efficient to minimize delay. 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 bariatric patients. The complete history and physical examination often suggest the probable cause (Table 23–1), allow for timely formation of a differential diagnosis, and guide the choice of appropriate initial diagnostic studies.

Table 23–1.Common causes of the acute abdomen.1

Depending on the degree of clinical suspicion and status of the patient, 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. If unclear or when in doubt, it is always appropriate to be a little aggressive and pursue additional tests, if needed. This chapter provides important insights and a useful framework to efficiently diagnose and manage a patient with an acute abdomen.

HISTORY

Abdominal Pain

Despite availability of advanced imaging techniques, the fundamental aspect of evaluation is history taking and physical exam. Taking a patient history is ...

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