[Acute epigastric pain]

Epigastric pain is a frequent complaint in emergency patients and shows a wide spectrum of differential diagnostic possibilities. Dangerous causes with life threatening consequences have to be ruled out as soon as possible, including causes of extra abdominal organs (heart, great vesels). After checking for and adequate treatment of vital parameters an efficient management strategy should consider the acuteness of symptoms, as velocity of pain onset is often related to its seriousness (aneurysmatic rupture of great vessels, parenchymal damage or infarction). A rare cause of acute epigastric pain is bleeding or rupture of renal or hepatic cysts. Imaging techniques, such as ultrasound and computed tomography, are helpful in finding the correct diagnosis without loosing to much time. Therapy depends on aetiology and dignity of the lesion, often an invasive surgical intervention is the only possibility to confirm the correct diagnosis.