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“An acute abdomen” denotes any sudden, spontaneous, nontraumatic disorder whose chief manifestation is in the abdominal area and for which urgent operation may be necessary. Because there is frequently a progressive underlying intra-abdominal disorder, undue delay in diagnosis and treatment adversely affects outcome.

The approach to a patient with an acute abdomen must be orderly and thorough. An acute abdomen must be suspected even if the patient has only mild or atypical complaints. The history and physical examination should suggest the probable causes 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 thoroughly familiar with the presenting pattern of the most common causes of an acute abdomen (Table 21–1). Moreover, they should be familiar with the disease patterns specific to the region and locality where they practice. Other chapters in this book provide detailed descriptions of specific diseases and their management.

Table 21–1. Common Causes of the Acute Abdomen.1

Abdominal Pain

History taking by an experienced physician is an active process whereby a cluster of diagnostic possibilities is 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, the mode of onset and progression, and the character of the pain will suggest a preliminary list of differential diagnoses.

Location of Pain

Because of the complex dual visceral and parietal sensory network innervating the abdominal area, pain is not as precisely localized as in the extremities. Fortunately, some general patterns do emerge that provide clues to diagnosis. Visceral sensation is mediated primarily by afferent C fibers located in the walls of hollow viscera and in the capsules of solid organs. Unlike cutaneous pain, visceral pain is elicited ...

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