Introduction
This topic covers the acute abdomen as a clinical syndrome and, in depth, intestinal obstruction: its types, clinical picture, diagnostic work-up and the principles of conservative and surgical treatment. Perforation and peritonitis are covered in the previous topic and vascular causes of acute abdomen in the following ones, so they are mentioned here only where they bear on obstruction.
The acute abdomen as a syndrome
The acute abdomen is a sudden, severe abdominal condition that usually needs urgent surgical assessment. It is a syndrome, not a diagnosis, and many different diseases can produce it. The first task is to decide whether the patient needs an operation, and how quickly.
- Main groups: inflammatory (appendicitis, cholecystitis, pancreatitis, diverticulitis), perforation, obstruction, vascular (mesenteric ischaemia, strangulated hernia), haemorrhage and rarely gynaecological or urological causes.
- Key assessment elements: onset and character of pain, its migration, vomiting, bowel habit, fever, previous surgery and hernias, and examination for guarding, rigidity, rebound and distension.