Approach to the acute abdomen

As our population ages, more patients will be presenting with acute abdominal problems which require attention. Unlike younger patients, the aged present later in the course of their disease and also often have concomitant underlying diseases. The diagnosis of an acute abdomen is further complicated by the relative lack of physical findings which is due to the elderly's lack of pain perception. The surgical problems in the elderly also tend to be more rapidly life-threatening than in younger patients. This further emphasizes the need for rapid diagnosis should an elderly patient present with abdominal pain. Methods to decrease the mortality from acute surgical problems are limited, but are potentially very effective. The first is to arrange for elective correction of the problem should it be known, and the second is to refer the patients promptly for operative consideration before sepsis becomes firmly established. Exact diagnosis before referral, while intellectually satisfying, is often contributory to a poor outcome in these patients.