Acute Abdomen

What is acute abdomen?

Acute abdomen is a term healthcare providers use to describe sudden, severe abdominal pain that may require urgent treatment. It often indicates a medical emergency, and pain may be the only sign that you need immediate surgery. However, acute abdomen may also be a symptom of a nonsurgical condition.

Conditions that can cause acute pain in your abdomen include:

• Infections and inflammation.
• Bleeding (hemorrhaging) and blood flow blockages.
• Obstructions and perforations.
• Endocrine and metabolic issues.
• Hematologic problems.

Who does it affect?

Acute abdomen can affect anyone. Factors that determine what types of conditions may cause you acute abdominal pain include:

• Your age.
• Your sex assigned at birth.
• Your medical history.

For instance, appendicitis is more common in people in their teens and 20s, and diverticulitis is more common in people over age 60. Women and people assigned female at birth (AFAB) may have acute abdomen due to a ruptured ectopic pregnancy. Men and people assigned male at birth (AMAB) may have sudden pain due to testicular torsion.

People with a history of certain medical conditions can also develop acute abdominal pain.

How common is this condition?

The exact number of people who experience acute abdomen is unknown. But abdominal pain accounts for between 7% and 10% of emergency department visits.

What are the signs and symptoms of acute abdomen?

The most common acute abdomen symptom is sudden, severe pain in your abdominal region. In addition, other acute abdomen signs may include:

• Distended abdomen: Abdominal distention means your abdomen is extensively swollen beyond its normal size.
• Symptoms of shock: Shock may cause rapid heart rate, low blood pressure, sweating and confusion.
• Symptoms of peritonitis: Inflammation of the inside of your abdomen (peritonitis) may cause constant pain or pain that gets worse when you gently touch the area or bump into it.

What causes acute abdomen?

Many different health conditions can cause acute abdomen. These causes may be surgical — meaning they likely require surgery — or nonsurgical.

Surgical acute abdomen causes include blood loss, infections, blood flow blockages, obstructions and perforations.

Blood loss (hemorrhage)

Hemorrhage is the loss of blood due to damaged blood vessels. Causes of hemorrhage include:

• Mallory-Weiss tear.
• Ruptured ectopic pregnancy.
• Trauma.
• Ruptured spleen.
• Ruptured abdominal aortic aneurysm.

Infections

Various infections can cause acute abdomen, including:

• Appendicitis.
• Cholecystitis.
• Peptic ulcer disease.
• Acute pancreatitis.
• Diverticulitis.

Blood flow blockage (ischemia)

Ischemia is when blood flow to a certain part of your body is reduced or restricted. Causes of ischemia include:

• Buerger’s disease.
• Colitis.
• Mesenteric ischemia.
• Strangulated hernia.
• Testicular torsion.

Obstructions

An obstruction is something that blocks food and liquid from moving through your digestive system correctly. Examples that cause acute abdomen include:

• Inflammatory bowel disease (IBD).
• Intussusception.
• Small bowel obstruction.
• Large bowel obstruction.

Perforations

Perforations are holes that form in the walls of your body’s organs. Examples of perforations that can cause acute abdomen include:

• Boerhaave’s syndrome.
• Gastrointestinal perforation.
• Perforated stomach ulcer.
• Malrotation.

Nonsurgical causes most likely don’t require surgery. Nonsurgical causes of acute abdomen include endocrine and metabolic disorders, hematologic disorders, and toxins or drugs.

Endocrine and metabolic disorders

These disorders involve the hormones, chemicals and glands of your endocrine system. Causes of acute abdomen may include:

• Uremia.
• Diabetes-related ketoacidosis (DKA).
• Addison’s disease.
• Acute intermittent porphyria.

Hematologic disorders

Hematologic disorders are conditions involving your blood, blood cells, lymph nodes, bone marrow and platelets. Conditions that may cause acute abdomen include:

• Sickle cell disease.
• Acute leukemia.
• Certain genetic disorders.
• Anemia.

Toxins

Toxins from drugs, chemicals and bites may cause acute abdomen. Causes may include:

• Lead poisoning.
• Other heavy metal intoxications.
• Nicotine withdrawal.
• Black widow spider bite poisoning.
• Some scorpion stings.

How is acute abdomen diagnosed?

If you go to the emergency room (ER) with severe abdominal pain, healthcare providers will immediately begin trying to figure out the cause of it. A provider will ask you a series of questions about:

• Your medical history, including any gastrointestinal (GI) issues.
• The exact location of your pain.
• The time the pain started and a description of the pain.
• What makes the pain feel better and what makes it feel worse.
• Similar symptoms you’ve had in the past.
• Any other new symptoms you have.
• Any prescription and nonprescription drugs you take.
• Previous abdominal surgeries.
• Recent changes or issues with your bowel or urinary habits.

In addition, they’ll ask women and people AFAB whether they are or could be pregnant.

The provider will then perform a physical exam, focusing on your abdomen. They’ll examine the skin of your abdominal region and look for any external abnormalities. They’ll use a stethoscope to listen to your bowel sounds (auscultate). Then, the provider will gently touch (palpate) your entire abdominal area, looking for any tender areas or masses.

The location of your pain can help the provider make the correct diagnosis. For instance, you’ll usually feel acute diverticulitis pain in the lower left quadrant of your abdomen. But you typically feel cholecystitis pain in the upper right quadrant.

For gastrointestinal or prostate issues, the provider will likely perform a digital rectal exam. For gynecological issues, they’ll perform a pelvic exam. For a suspected testicular torsion, they’ll perform a testicular exam.

What your provider learns through the answers to their questions and your physical exam helps them narrow down the list of possible diagnoses. It could also add additional possibilities. Together, these factors will help them determine what, if any, diagnostic tests to order.

What tests will be done to diagnose acute abdomen?

If your healthcare provider knows the cause of your acute abdomen symptoms, they may move immediately to surgery and not request any tests. However, if they aren’t sure of the exact cause, they may need tests to help make a diagnosis. Your provider will order different tests based on their findings during your physical exam. They’ll order specific tests based on what they suspect may be causing your acute abdomen.

Laboratory tests may include:

• Complete blood count (CBC).
• Comprehensive metabolic panel (CMP).
• Arterial blood gas (ABG).
• Amylase test.
• Liver function tests.
• Kidney function tests.
• Urinalysis.

Imaging tests may include:

• Abdominal ultrasound.
• Abdominal computed tomography (CT) scan.
• Endoscopic ultrasound.

How is acute abdomen treated?

Treatment will vary based on the cause of your acute abdomen. No matter the cause, rapid diagnosis and treatment are vital. If the cause of acute abdomen needs emergency surgery, your provider will immediately call in a surgeon for consultation. Your providers may take you into surgery immediately.

If the cause of acute abdomen is nonsurgical, treatment may include:

• Stabilization and monitoring of your vital signs.
• Replenishment of fluids and electrolytes.
• Broad-spectrum antibiotics.
• Pain relievers.
• Anti-emetics (medications that prevent and treat nausea and vomiting).

How can I prevent acute abdomen?

Acute abdomen has many different possible causes, and most of them aren’t preventable. The best way to prevent acute abdomen is to lead a healthy lifestyle. That includes:

• Eating a balanced diet.
• Exercising.
• Seeing your healthcare provider regularly.
• Quitting smoking.

What can I expect if I have acute abdomen?

Your outlook (prognosis) depends on the cause of your condition. With immediate treatment, you’re likely to have a better outcome.

If left untreated, acute abdomen may cause complications, including:

• Fistula (an abnormal connection between structures in your body that should be separate from each other).
• Necrosis of your bowels.
• Sepsis.
• Death.

When should I see my healthcare provider?

You should see a healthcare provider if you have ongoing (chronic) abdominal pain that lasts for weeks and/or doesn’t seem to be getting any better. Abdominal pain has many causes. A provider can help diagnose your condition and determine the correct treatment.

When should I go to the ER?

If you have sudden, severe abdominal pain, you should call 911, your local emergency services number or go to your nearest emergency room immediately. Your condition could be life-threatening if you don’t seek immediate treatment.

What questions should I ask my doctor?

• What caused my acute abdominal pain?
• Will I need further treatment?
• Can I prevent it from happening again?
• What’s the difference between acute and chronic abdominal pain?

A note from Cleveland Clinic

Everyone experiences abdominal pain at one point or another. The pain usually isn’t serious and often goes away on its own. However, acute abdomen can be a sign of a medical emergency. If you develop sudden, severe abdominal pain, it’s important to get yourself to an emergency room right away. Healthcare providers can determine the cause of your pain and get you immediate treatment. Untreated acute abdomen can lead to serious complications.