Definition

Acute abdomen is the medical term used for pain in the abdomen that usually comes on suddenly and is so severe that a person may seek emergency treatment. Acute abdominal pain can signal a variety of more serious conditions, some of which require immediate medical care and/or surgery.

Causes

There are a number of possible causes of acute abdomen. These may include:

• Viral gastroenteritis—stomach flu
• Intestinal obstruction
• Hernia
• Appendicitis—inflammation of the appendix
• Pancreatitis—inflammation of the pancreas
• Diverticulitis—inflammation of small pouches that form in the large intestine
• Cholecystitis—inflammation of the gallbladder, with or without gallstones
• Cholangitis—inflammation of the bile duct caused by a gallstone or a bacterial infection
• Gastritis—inflammation of the stomach lining, such as from drinking too much alcohol or prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs)
• Kidney, bladder, or urinary tract infection
• Kidney stones
• Ulcerative colitis or Crohn’s disease—inflammatory diseases of the intestines
• Sickle cell crisis
• Diabetic ketoacidosis—dangerously high levels of acids in the blood
• Ruptured or leaking abdominal aortic aneurysm—abnormally large blood vessels in the abdomen
• Ischemia—inadequate, or blocked, blood supply to one of the abdominal organs
• Infectious diarrhea /abdominal abscess
• Irritable bowel syndrome (IBS)
• Heartburn or gastroesophageal reflux disease (GERD)
• Peptic ulcer
• Heart attack
• Cancer
• Pneumonia
• In women:
  • Menstrual cramps
  • Endometriosis
  • Uterine fibroids
  • Ovarian cysts
  • Pelvic inflammatory disease—inflammation around the ovaries, uterus, and fallopian tubes
  • Miscarriage or ectopic pregnancy
• In infants:
  • Intussusception —the telescoping of one portion of the intestine into another, causing obstruction of the bowel and blockage of its blood flow
  • Volvulus—a twisting of the colon around itself
  • Hirschsprung’s disease—also known as congenital megacolon
  • Other congenital defects of the digestive tract

Risk Factors

Factors that increase your risk of acute abdomen will depend on the cause.

Symptoms

The symptoms of acute abdomen have a variety of causes. If you experience any one of them, see your physician.

• Persistent, severe pain, swelling, and/or tenderness in the upper, middle, or lower abdomen
• Guarding—involuntary contraction of the abdominal muscles
• Rigidity—when abdominal muscles are tense and board-like
• Fever

Diagnosis

You will be asked for details about your pain, such as the exact location and duration. You will also be asked about any additional symptoms you may be having, such as bowel or urinary symptoms. A medical history will be taken. You will be asked about any drugs or medications you’ve taken. A physical exam will be done, including rectal and pelvic examinations.

Your bodily fluids may be tested. This can be done with:

• Blood tests
• Urine analysis

Your bodily structures may need to be viewed. This can be done with:

• Ultrasound
• CT scan
• MRI scan
• KUB (kidney, ureter, and bladder) x-rays
• Barium x-rays
• Angiography
• Endoscopy

Surgery may be done to visually examine the abdomen.

Treatment

You may be given pain relievers. However, many doctors may delay prescribing pain relievers, since details of the pain can help find its cause. Do not take any medication, and do not eat or drink until you have spoken with your doctor.

Talk with your doctor about the best treatment plan for you. Depending on the underlying condition causing your acute abdomen, treatment options may include:

• Medications
• Diet or lifestyle changes
• Advanced medical treatment such as surgery—may be required for the majority of severe abdominal pains that last for at least 6 hours in previously healthy patients

Prevention

Depending on the underlying condition causing acute abdomen, prevention measures will vary. Talk with your doctor about preventing conditions that cause acute abdomen.

National Digestive Diseases Information Clearinghouse (NDDIC) http://digestive.niddk.nih.gov

Canadian Digestive Health Foundation http://www.cdhf.ca

Cartwright S, Knudson M. Evaluation of Acute Abdominal Pain in Adults. Am Fam Physician. 2008 Apr 1;77(7):971-978. Available at:
http://www.aafp.org/afp/2008/0401/p971.html
Accessed June 4, 2015.

Leung A, Sigalet D. Acute abdominal pain in children. Am Fam Physician. 2003 June 1;67(11):2321-2327. Available at:
http://www.aafp.org/afp/20030601/2321.html
Accessed June 4, 2015.

Zeller JL. Acute abdominal pain. JAMA. 296(14):1800. Available at:
http://jama.ama-assn.org/cgi/content/full/296/14/1800
Accessed June 4, 2015.