The acute abdomen: Structured diagnosis and treatment

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. This narrative review is based on publications retrieved by a PubMed search, current textbooks and guidelines, and the authors' personal experience. 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. Structured, quality-controlled, rapid, and targeted diagnosis and treatment markedly lower the morbidity and mortality of patients presenting with an acute abdomen.