Introduction
This topic covers the acute abdomen as a clinical syndrome, the inflammation of the peritoneum (peritonitis) that most often follows it, and the perforation of hollow abdominal organs, which is its commonest surgical cause. The aim is to recognise a patient who needs urgent surgery, identify the source of the problem and start treatment in the right order.
Acute abdomen syndrome
The acute abdomen is a sudden, severe abdominal pain or a clinical picture of an urgent intra-abdominal disease, usually lasting less than a week, that requires a rapid decision between operation and observation. It is a syndrome rather than a diagnosis, so the answer must name the underlying cause.
- Typical causes: acute appendicitis, perforated peptic ulcer, acute cholecystitis, intestinal obstruction, bowel ischaemia, acute pancreatitis, ruptured aortic aneurysm and perforation of a hollow organ.
- Non-abdominal causes that mimic it: inferior myocardial infarction, lower lobe pneumonia, diabetic ketoacidosis, porphyria and lead intoxication.
- Key history: onset and character of the pain, its migration, relation to meals, previous similar episodes, vomiting, fever, bowel habit, urinary symptoms and drugs such as NSAIDs or corticosteroids.
- Key examination: general state and signs of shock, inspection, palpation for localised tenderness, guarding, rigidity and rebound, auscultation of bowel sounds, hernial orifices, and rectal and pelvic examination, including in women.