Acute abdominal pain
Citation, DOI, disclosures and article data
At the time the article was created Daniel J Bell had no recorded disclosures.View Daniel J Bell's current disclosures
At the time the article was last revised Daniel J Bell had no financial relationships to ineligible companies to disclose.View Daniel J Bell's current disclosures
Acute abdominal pain is a common acute presentation in clinical practice. It encompasses a very broad range of possible etiologies and diagnoses, and imaging is routinely employed as the primary investigative tool in its modern management.
On this page:
A subgroup of patients with acute abdominal pain will have a so-called acute abdomen (also known as an acute surgical abdomen). This is restricted to those with an acute presentation of abdominal pain coupled with serious morbidity, a tender abdomen and marked rigidity (a.k.a. involuntary guarding) on abdominal physical examination.
It is estimated that approximately 5% presentations to a typical emergency department are for acute abdominal pain 1.
Acute abdominal pain includes a wide spectrum of severity and differing character, with qualifying descriptors, such as sharp, colicky, dull, etc.
The list of causes of acute abdominal pain is extremely long and can be subdivided in a multiplicity of ways.
acute visceral inflammation
peptic ulcer disease: gastric or duodenal ulcer
mesenteric adenitis: common differential for appendicitis in young
pregnancy: sometimes it maybe 'concealed', i.e. patient may not even be aware!
Less common causes
intraperitoneal focal fat infarction
perigastric appendagitis (very rare) 9
Many medical conditions can present with acute abdominal pain. In some cases it may be an atypical presentation of a common condition (e.g. myocardial ischemia), or a typical presentation of a rare condition (e.g. porphyria). This list is not exhaustive (in medicine they rarely are!).
abdominal muscle injury e.g. rectus abdominis muscle strain
opiate withdrawal: classically heroin
latrodectism: envenomation by Latrodectus (black widow spiders)
Functional GI disorders
CT of the abdomen and pelvis is the first-line investigation for many presentations of acute abdominal pain. Traditionally, the plain abdominal radiograph was the initial investigation but has fallen out of favor due to its poor sensitivity and specificity for many of the causes of abdominal pain.
Historically the plain abdominal radiograph was mandatory in every patient presenting with an acute abdomen.
to be completed
Treatment and prognosis
In the pre-CT era, patients with an acute abdomen were often sent for urgent surgery. Contemporaneously, with the virtually ubiquitous availability of CT, some of these patients will not be operated on at all. Conversely, some patients who do not meet the traditional criteria for an "acute abdomen" will be diagnosed on imaging with conditions, such as acute appendicitis, and be sent for surgery.
A pragmatic approach needs to be taken by clinicians/radiologists when considering the potential causes of an acute abdomen and a surgical sieve may be helpful as a starting point.
Beware of a normal abdominal radiograph providing a false sense of security. Emergent pathologies including bowel obstruction and perforation may not produce a radiographic abnormality.
- 1. Stoker J, van Randen A, Laméris W, Boermeester MA. Imaging patients with acute abdominal pain. (2009) Radiology. 253 (1): 31-46. doi:10.1148/radiol.2531090302 - Pubmed
- 2. Li P, Tee Y, Fu C et al. The Role of Noncontrast CT in the Evaluation of Surgical Abdomen Patients. Am Surg. 2018;84(6):1015-21. - Pubmed
- 3. Krajicek E & Hansel S. An Acute Care Approach to Functional Abdominal Pain. JAAPA. 2017;30(10):17-21. doi:10.1097/01.JAA.0000524711.32966.57 - Pubmed
- 4. Salameh S, Antopolsky M, Simanovsky N, Arami E, Hiller N. Use of Unenhanced Abdominal Computed Tomography for Assessment of Acute Non-Traumatic Abdominal Pain in the Emergency Department. Isr Med Assoc J. 2019;21(3):208-12. - Pubmed
- 5. Thakur R, Singh R, Nepal S, Ghimire P. An Unusual Case of Tetanus Masquerading as an Acute Abdomen: A Case Report. Clin Pract Cases Emerg Med. 2020;4(4):599-602. doi:10.5811/cpcem.2020.8.49073 - Pubmed
- 6. Mueller P & Benowitz N. Toxicologic Causes of Acute Abdominal Disorders. Emerg Med Clin North Am. 1989;7(3):667-82. - Pubmed
- 7. Schuppisser M, Khallouf J, Abbassi Z et al. Abdominal Mondor Disease Mimicking Acute Appendicitis. Int J Surg Case Rep. 2016;20:37-40. doi:10.1016/j.ijscr.2015.12.031 - Pubmed
- 8. Pal N & Fernandes Y. Intestinal Angioedema: A Mimic of an Acute Abdomen. Cureus. 2023;15(2):e34619. doi:10.7759/cureus.34619 - Pubmed
- 9. Justaniah A, Scholz F, Katz D, Scheirey C. Perigastric Appendagitis: CT and Clinical Features in Eight Patients. Clin Radiol. 2014;69(12):e531-7. doi:10.1016/j.crad.2014.08.020 - Pubmed