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Part VI ♦ Special Subjects

ACUTE ABDOMEN General Principles

I. Acute surgical abdomen: Acute onset of severe abdominal pain; emergent (immediate) or urgent (minimal delay) surgical evaluation. II. Pain characteristics: Can give clues to pathology (Fig. 18-1). A. Abrupt, excrutiating pain: Suggests perforation, colic, or myocardial infarction. B. Rapid onset, severe, constant pain: Suggests strangulated bowel, acute pancreatitis, or ectopic pregnancy. C. Gradual, steady pain: Suggests acute cholecystitis, diverticulitis, or appendicitis. D. Intermittent, colicky pain: Suggests small bowel obstruction (SBO) or inflammatory bowel disease.

Abrupt, excruciating pain

Rapid onset of severe, constant pain

Myocardial infarction

Acute pancreatitis

Ruptured aneurysm Perforated ulcer

Mesenteric thrombosis strangulated bowel

Biliary colic

Ureteral colic

Ectopic pregnancy

Gradual, steady pain

Intermittent, colicky pain crescendo with free intervals

Acute cholecystitis, acute cholangitis, acute hepatitis

Early pancreatitis (rare)

Small bowel obstruction Inflammatory bowel disease

Appendicitis acute salpingitis ,

Diverticulitis

Figure 18-1: The differential diagnosis of the acute abdomen can be narrowed by location and character of pain. From Britt LD, Peitzman AB, Barie PS, Jurkovich GJ: Acute Care Surgery, 2nd ed. Wolters Kluwer Health, 2018, Fig. 41.1 (Adapted from Doherty GM, ed. The acute abdomen. In: Doherty GM, eds. Current Surgical Diagnosis and Treatment. 13th ed. New York, NY: McGraw-Hill/Lange; 2009:454; Figure 21.3).