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The Acute Abdomen: Structured Diagnosis and Treatment
Nikolaus Börner1, Alina-Sophie Kappenberger, Sabine Weber
1Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Germany; Department of Medicine II, LMU Klinikum Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Germany.
Background:
The acute abdomen is a life-threatening clinical entity that requires immediate diagnostic evaluation and appropriate treatment. 15-20% of emergency room patients with acute abdominal pain need interventional or surgical treatment.
Methods:
This narrative review is based on publications retrieved by a PubMed search, current textbooks and guidelines, and the authors' personal experience.
Results:
The acute abdomen presents with the sudden onset of maximally intense abdominal pain, sometimes with guarding, and often with impaired general well-being, ranging to manifestations of shock. Its more common causes, aside from nonspecific abdominal pain (30-41%), are acute appendicitis (8-30%), cholecystitis (9-11%), and ileus (4-5%). The diagnosis is established by the history and physical examination, laboratory tests, imaging studies, and, in some cases, exploratory laparoscopy. The acute abdomen is generally a surgical condition, but it often requires interdisciplinary, multimodal treatment and follow-up. It carries a 2% to 12% mortality, with the figure rising for every elapsed hour until specific treatment is provided.
Conclusion:
Structured, quality-controlled, rapid, and targeted diagnosis and treatment markedly lower the morbidity and mortality of patients presenting with an acute abdomen.
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