Acute abdomen

Introduction

Acute abdomen refers to the sudden onset of severe abdominal pain, developing over less than seven days and potentially requiring emergency surgical management. It is not a single disease but a syndrome that can reflect numerous digestive, gynecological, urological, or vascular pathologies. It is one of the most frequent reasons for consultation in the emergency room. The challenge is to quickly distinguish benign causes from life-threatening emergencies such as peritonitis, mesenteric ischemia, or ruptured aneurysm.

If you experience unusual acute abdominal pain, contact your primary care physician first. If they are unavailable, Docadom offers an emergency consultation by a home doctor: call 021 845 45 45 or use our app available on the App Store and Google Play.

Who is at risk of suffering from it?

Anyone can be affected, but certain profiles are more exposed. The elderly are at risk for vascular pathologies (mesenteric ischemia, aortic aneurysm), obstructions, and diverticulitis. Children primarily present with appendicitis and intussusception. Women of childbearing age are exposed to gynecological causes (ectopic pregnancy, adnexal torsion, salpingitis). Patients with a history of abdominal surgery are at risk of adhesion-related obstruction. Immunocompromised patients may present with atypical clinical pictures despite serious pathologies.

Symptoms of Acute Abdomen

Acute abdomen manifests as a combination of digestive and general signs whose intensity and location point to a specific cause. Recognizing the warning signs helps avoid a delay in management.

Main Symptoms

• Abdominal pain: the cardinal symptom, sudden or progressive; its location, radiation, and intensity are decisive.

• Nausea and vomiting: sometimes food-related, bilious, feculent (obstruction), or bloody (digestive hemorrhage).

• Transit disorders: diarrhea, constipation, or complete cessation of stool and gas suggestive of an obstruction.

• Abdominal distension: bloated abdomen, sometimes associated with a palpable mass.

• Fever and chills: point to an infectious cause (appendicitis, peritonitis, salpingitis).

• Peritoneal signs: guarding, rigidity (board-like abdomen), rebound tenderness — mandate emergency surgery.

• Signs of shock: paleness, sweating, tachycardia, hypotension, fainting — suggest internal bleeding or severe sepsis.

When to Consult in an Emergency?

An emergency consultation is essential in the following cases:

• Sudden, very intense, or rapidly worsening abdominal pain.

• Pain associated with signs of shock or abdominal guarding — call 144 immediately.

• Feculent, bloody vomiting, or rectorrhagia.

• Complete cessation of stool and gas.

• Pain in a pregnant woman or woman of childbearing age with a missed period.

• Pain in an infant, child, elderly person, or immunocompromised patient.

• Recent history of abdominal surgery or trauma.

What to do before calling Docadom? First, contact your primary care physician, who knows your digestive and surgical history. If they are unreachable or if you need a doctor at home outside of opening hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone app (App Store and Google Play). In case of signs of severity (unbearable pain, guarding, signs of shock, bloody vomiting), dial 144 without delay.

Causes of Acute Abdomen

The causes are numerous and are classified according to their anatomical origin.

Surgical Digestive Causes

Acute appendicitis, acute cholecystitis, intestinal obstruction (adhesions, hernias, tumor, volvulus), perforation of an ulcer or of the digestive tract, complicated sigmoid diverticulitis, peritonitis, mesenteric ischemia, and abundant digestive hemorrhages often require emergency surgery.

Medical Digestive Causes

Acute pancreatitis (biliary or alcoholic), acute colitis, acute hepatitis, severe gastroenteritis, flare-ups of inflammatory bowel disease, and biliary colic due to gallstones require specialized medical management.

Gynecological and Urological Causes

In women: ectopic pregnancy (life-threatening emergency), adnexal torsion, ruptured ovarian cyst, salpingitis. In men and women: renal colic, acute pyelonephritis, acute urinary retention. In young men: testicular torsion, an absolute surgical emergency.

Vascular and Extra-Abdominal Causes

Some serious vascular causes like rupture of an abdominal aortic aneurysm or aortic dissection can mimic common abdominal pain. Extra-abdominal pathologies (myocardial infarction, pulmonary embolism, basilar pneumonia) sometimes cause pain referred to the abdomen.

Diagnosis of Acute Abdomen

Diagnosis is based on medical history, a rigorous clinical examination, and targeted additional investigations.

Diagnostic Methods

• Physical examination: inspection, palpation, percussion, auscultation, checking for guarding, rigidity, and peritoneal signs.

• Laboratory workup: CBC, CRP, electrolytes, kidney function, liver panel, lipase, β-HCG in any woman of childbearing age.

• Urinalysis and urine culture in case of urinary signs.

• ECG in elderly patients to ensure a myocardial infarction is not missed.

• Abdominal and pelvic ultrasound: non-radiating examination, first line in pregnant women and children.

• Abdominopelvic CT scan: gold standard examination in adults, particularly precise.

• MRI: useful in pregnant women or to supplement a CT scan.

Differential Diagnoses

Several conditions can mimic an acute abdomen:

• Appendicitis: migrating pain in the right iliac fossa, moderate fever.

• Cholecystitis: pain in the right hypochondrium with Murphy's sign.

• Acute pancreatitis: band-like radiating pain with elevated lipase.

• Intestinal obstruction: cessation of stool and gas, vomiting.

• Ectopic pregnancy in women of childbearing age.

• Renal colic with radiation to the loin and groin.

• Pulmonary embolism or myocardial infarction presenting with abdominal symptoms.

• Gastroenteritis with diffuse pain and transit disorders.

Management and Treatment

Acute abdomen is a medical-surgical emergency. Management aims to stabilize the patient, relieve pain, identify the cause, and treat the underlying pathology.

Stabilization and Pain Relief

Insertion of an intravenous line, monitoring of vital signs, keeping the patient nil per os (NPO), sometimes a nasogastric tube and urinary catheter. Pain treatment must no longer be delayed: paracetamol, antispasmodics (phloroglucinol), NSAIDs for renal colic, morphine or oxycodone for severe pain.

Specific Medical Treatment

Antibiotics cover Gram-negative bacilli and anaerobes (amoxicillin-clavulanic acid, piperacillin-tazobactam, metronidazole). Proton pump inhibitors treat ulcers and upper gastrointestinal bleeding. Therapeutic endoscopy can treat certain digestive hemorrhages or remove a common bile duct stone (ERCP).

Surgical Treatment

Laparoscopy (minimally invasive surgery) is now preferred: appendectomy, cholecystectomy, obstruction repair, suture or resection in case of perforation, sigmoidectomy for complicated diverticulitis, gynecological surgery in case of ectopic pregnancy or adnexal torsion, emergency vascular surgery for ruptured aneurysm or mesenteric ischemia.

Prevention of Acute Abdomen

Many causes are not preventable, but certain risk factors can be controlled:

• A balanced diet rich in fiber to prevent constipation, diverticulosis, and gallstones.

• Sufficient hydration (1.5 to 2 liters per day) to reduce the risk of renal colic.

• Limiting alcohol (prevention of chronic pancreatitis and cirrhosis).

• Smoking cessation, a risk factor for ulcers and oncology.

• Maintaining a healthy weight.

• Compliance with food hygiene rules to prevent gastroenteritis.

• Colorectal cancer screening from age 50.

• Monitoring patients with a chronic digestive disease or an aortic aneurysm.

Possible Complications

Generalized peritonitis is the most feared complication. It manifests as a rigid abdomen, high fever, deterioration of general condition, and can progress to septic shock with multi-organ failure. It requires emergency surgery and heavy intensive care.

Other complications include hemorrhagic shock (ruptured aneurysm, ectopic pregnancy, gastrointestinal bleeding), intestinal necrosis, sepsis and septic shock, post-operative complications (abscesses, fistulas, eviscerations, adhesion-related obstructions), thromboembolic complications (phlebitis, pulmonary embolism), and functional or psychological sequelae.

When to Contact a Doctor for Acute Abdominal Pain

Any severe or unusual abdominal pain warrants prompt medical advice. Here is what to do:

• As a first resort: contact your primary care physician. Only they know your digestive and surgical history, and current treatments.

• If your primary care physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a doctor at home. Call 021 845 45 45 or make your request via our mobile app, available for free on the App Store and Google Play.

• In case of signs of severity (unbearable pain, hard abdomen, signs of shock, bloody vomiting), dial 144 without delay.

Conclusion: Rapid Diagnosis and Management Save Lives

Acute abdomen is a syndrome encompassing a wide range of pathologies, from benign gastroenteritis to life-threatening emergencies like peritonitis, mesenteric ischemia, or ruptured aortic aneurysm. It is characterized by acute and intense abdominal pain which may be associated with vomiting, fever, transit disorders, or signs of shock, which can lead to serious complications in elderly patients, pregnant women, children, or immunocompromised individuals.

In case of acute abdominal pain, contact your primary care physician first. If they are not available, Docadom provides you with an emergency home doctor 7 days a week: call 021 845 45 45 or use our mobile app (App Store, Google Play) to request an emergency consultation.