[Acute abdomen - a practical approach]

Acute abdomen describes a critical clinical condition which includes a heterogeneous group of clinical presentations. Several diseases require immediate surgical treatment. Therefore, fast radiological assessment is demanded.

Stable patients presenting at the emergency department with acute abdominal pain require an abdominal x‑ray, an ultrasound examination and/or a computed tomography (CT) scan, depending on the location and character of their pain. These standard radiological methods provide a quick differentiation between simple and complicated pathologies. Unstable patients should undergo immediate CT and, if positive, be sent directly to surgery.

The ongoing technical developments in the field of computed tomography allow a quick and detailed characterization of pathologic conditions of the abdominal organs. A structured approach, based on the analysis of typical radiological signs and patterns, combined with the evaluation of extra-abdominal findings helps to assign the observed imaging findings to specific diseases.

A systematic 4‑point approach for structured analysis of specific and nonspecific imaging features and common pitfalls aids to choose the correct radiological method and help to narrow the broad spectrum of potential differential diagnoses.