Abstract
Introduction
Acute abdomen is one of the commonest causes of admission in the surgical emergency room, and it encompasses a spectrum of surgical conditions, which requires hospital admission, thorough investigations and prompt treatment in the form of surgical intervention except in few cases, where conservative management is preferred to avoid an unnecessary and difficult surgery (Haworth IE, 1992).
Pain, the most common presenting symptom may be located in any quadrant of the abdomen and its location is a useful starting point that should guide further workup. Similarly, character, nature and intensity of the pain also indicate indirect evidence of underlying cause of acute abdomen. Colicky pain is typically associated with obstructive processes, while pain that is continuous is usually the result of underlying ischemia or peritoneal inflammation (Brewer RJ, Golden GT and Hitch DG, 1976).
The pattern of radiation of pain may provide important clues as to its origin. Pain that involves the entire abdomen almost immediately after onset is usually due to flooding of the peritoneal cavity with an irritating fluid from a perforated ulcer, or from blood and chorionic tissue in a ruptured ectopic pregnancy (Kamin RA, Nowicki TA, Courtney DS, et al., 2003).
The important signs of acute surgical abdomen are the abdominal guarding, rigidity and rebound tenderness. Guarding is a characteristic finding in the physical examination for an abruptly painful abdomen (an acute abdomen) with inflammation of the inner abdominal (peritoneal) surface wherein, the tensed muscles of the abdominal wall automatically go into spasm to keep the tender underlying tissues from being disturbed (Leung AK and Sigalet DL, 2003).
Age differences play a crucial role and are important to be considered when assessing the acute abdomen. As with age not only the incidence of certain pathologies changes but also the clinical presentation varies.
References
- Adhikari S, Hossein MZ, Das A, et al. Etiology & outcome of acute intestinal obstruction: A review of 376 patients in Eastern India. Saudi J gastroenterology, 16 :2010, 285 -7.)
- Agboola JO, Olatoke SA, Rahman GA. Pattern and presentation of acute abdomen in a Nigerian teaching hospital. Niger Med J 2014; 55(3):266-270.
- Ahmed A. Emergency abdominal surgery in Zaire. SAJS 2010; 48(2): 59-62.
- Al-Mulhim AA. Value of admission for observation in the management of acute abdominal right iliac fossa pain. Prospective study of 205 cases. Br J Surg 2014; 64: 249.
- Amyand C. Of an inguinal rupture, with a pin in the appendix coeci, incrusted with stone; and some observaions on wounds in the guts. Phil Trans Royal Soc 1736; 39: 329.
- Asefa Z. Pattern of acute abdomen in Yirgalem Hospital, southern Ethiopia. Ethiop Med J 2000; 38(4): 227-35.
- Aziz A, Bota R, Ahmed M. Frequency and Pattern of Intra- Abdominal Injuries in Patients with Blunt Abdominal Trauma. J Trauma Treat 2014; 3:196
- Bose SM, Kumar A, Chaudhary A, et al. Factor affecting mortality in small intestinal perforation. India J Gastroenterol 1986; 5:261-63
- Brewer RJ, Golden GT, Hitch DG. Abdominal pain: an analysis of 1000 consecutive cases in a university hospital. Am J Surg 1976; 131: 219-24.
- Cassina P, Röthlin M, Largiadèr F. Efficacy of basic surgical diagnosis in acute abdominal pain.Chirurg.1996;67(3):254-60.
- Chanana L, Moses AK, Yadav B. Clinical profile of non-traumatic acute abdominal pain presenting to emergency department. J Family Med Prim Care 2015; 4(3):422-425
- Chase CW, Barker DE, Russel WL, et al. Serum amylase and lipase in the evaluation of acute abdomen. Am J Surg 1996; 62(12): 1028-33.
- Cope Z. A History of the Acute Abdomen. London, Oxford University Press, 1965: pp. 123-355.
- Davies SJ, Wilson RJT. Preoperative optimization of the high-risk surgical patient. Br J Anaesth 2004; 93(1): 121-8.
- de Dombal FT. The OMGE acute abdominal pain survey. Progress report, 1986. Scand J Gastroenterol Suppl 1988; 144: 35-42.
- Doumi EBA, Mohammed MI. Abdominal pain as a cause of acute admission to hospital. JR Coll Surg Edinburgh 1992; 37(6): 389-93.
- Ellis H. Ephrain McDowell and the first successful elective laparotomy. Br J Med 2009; 70(2): 107.
- Flasar MH, Goldberg E. Acute abdominal pain. Med Clin North Am 2006; 90: 481-503.
- Frates MC, Laing FC. Sonographic evaluation of ectopic pregnancy: An update. Am J Roentgenol 1995; 165(2): 25-56.
- Fukuda N, Wada J, Niki M, Sugiyama Y, et al. Factors predicting mortality in emergency abdominal surgery in the elderly. World J Emerg Surg 2012; 7: 12.
- Gupta K, Bhandari RK. Comparative study of plain X-ray film abdomen and ultrasonography abdomen in non-traumatic acute abdomen. Gastrointestinal Radiology Journal 2005; 15(1): 109-115.
- Haworth IE. Abdominal pain as a cause of acute abdomen admission to hospital. JR Coll Surg Edinburgh 1992; 37: 389-93.
- Henderickson M, Naparst TR. Abdominal surgical emergencies in the elderly. Emerg Med Clin North Am 2003; 21(4): 937-69.
- Hustey FM, Meldon SW, Banet GA, et al. The use of abdominal computed tomography in older ED patients with acute abdominal pain. Am J Emerg Med 2005; 23: 259.
- Kamin RA, Nowicki TA, Courtney DS, et al. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am 2003; 21(1) :61-72.
- Karandikar S. Results of emergency management of acute abdomen in adults based on clinical assessment and basic imaging investigations: Are advanced imaging techniques always necessary for successful treatment. Int J Res Med Sci 2016; 4(6): 2064-8.
- Khan S, Alpar EK. Abdominal solid organ injuries in multi trauma patients, incidence and etiology: a retrospective analysis of 111 cases. J Surg 1997; 14: 44-47.
- Khan TS, Wani ML, Wani SN et al. Clinicopathological profile and management of acute mechanical small bowel obstruction: A prospective study. Arch ClinExpSurg 2013;2(3): 154-160.
- Khanna AK, Mishra MK. Typhoid perforation of the gut.Postgraduate Medical Journal. 1984; 60:523.
- Kortiso B, Abdurahman. Pattern of acute abdomen in adult patients, in Tikir Anbessa, Ethopia. East and Central African Journal of Surgery 2007; 12:47-52.
- Leung AK, Sigalet DL. Acute abdominal pain in children. Am Fam Physician 2003; 67(11): 2321-6.
- Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician 2006; 74(9): 1537-44.
- MacKersie AB, Lane MJ, Keenan A, Katz DS, et al. Nontraumatic acute abdominal pain. Am J Radiology 2005; 237(1): 114-22.
- McCollough M, Sharieff GQ. Abdominal pain in children. Pediatr Clin North Am 2006; 53(1): 107-37.
- McConkey SJ. Case series of acute abdominal surgery in rural Sierra Leone. World J Surg 2002; 26(4): 509-13.
- McCoy CC, Englum BR, Keenan JE, et al. J Trauma Acute Care Surg 2015; 78(5): 912-18.
- Mc Burney C. Experience with early operative interference in case of diseases of vermiform appendix. NYJ Med (1889); 50:676
- Morino M, Pellegrino L, Castagna E, Farinella E, et al. Acute nonspecific abdominal pain. A radomized, controlled trial comparing early laparoscopy versus clinical observation. Ann Surg 2006; 244(6): 881-8.
- Nega B. Pattern of acute abdomen and variables associated with adverse outcome in a rural primary hospital setting. Ethiop Med J 2009; 47(2): 143-51.
- Noon GP, Beall AC, Jorden GL, et al. Clinical evaluation of peritoneal irrigation with antibiotic solution.1967;67:73
- M, E. Rugwizangoga, G. Ntakiyiruta et al. Acute surgical abdomen, a prospective study at a teaching hospital. North African J Surgery 2015; 34:56-64
- Ohene-Yeboah M. Acute surgical admissions for abdominal pain in adults in Kumasi, Ghana. ANZ J Surg 2006;76(10): 898-903.
- Pujari A, Methi RN, Khare N. Acute gastrointestinal emergencies requiring surgeries in children. Am J Surg 1976; 36(4): 131-9.
- Raman SS, Osuagwo FC, Kadell B. Effect of CT on false positive diagnosis of appendicitis and perforation. N Engl J Med 2008; 358(9): 972-3.
- Ray S, Patel M, Parmar H. Management of acute abdomen: Study of 110 cases. IAIM 2016; 3(2): 18-24.
- Richard N, D Kruger, T E Luvhengo, et al. Clinical presentation of acute appendicitis in adults at the Chris Hani Baragwanath Academic Hospital. International Journal of Emergency Medicine 2014; 7:12.
- Sabiston DC, Townseed CM. Acute abdomen. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 18th Elsevier, 2008: 1180-96.
- Samir R, Patel M, Parmar H, et al. Management of acute abdomen: Study of 110 cases. IAIM, 2016; 3(2): 18-24.
- Shea JA, Berglin JA, Cabana MD, et al. Revised estimate of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1997; 154(22): 257-81.
- Sinha S, Kaushik R, Yadav TD. Mechanical bowel obstruction: The Chandigarh experience. Trop Gastroenterol, 2002; 23(1):13-15
- Silen W. Cope’s Early Diagnosis of the Acute Abdomen. New York: Oxford, 2010.
- Surathi K, Suthar K, Jainam et al. Study of recent trends in acute pancreatitis. Int J Med Public Health 2014; 3(1): 63-68.
- Svanes C, Salvesen H, Espehaug B, et al. A multifactorial analysis of factors related to lethality after treatment of perforated gastroduodenal ulcer. Ann of Surg. 1989; 209(4):418-23
- Svenningsen P, Manoharan T, Foss NB et al. Increased mortality in the elderly after emergency abdominal surgery. Dan Med J 2014; 61(7): A4876.
- Tariq W, Hina L, Bilquis S. An unusual cause of acute abdominal pain in dengue fever. Am Journal of Fam Med 2014; 32(7):819-821.
- Thomson HJ, Jones PF. Active observation in acute abdominal pain. Am Surg 1986; 152(5): 522-25.
- Vasavada P. USG evaluation of acute abdominal emergencies in infants and children. Radiol Clin North Am 2004; 42(2): 445-56.
- Wani M, Khan M, Durrani A, et al. Analysis of acute abdomen admissions in the surgical emergency room of a developing third world country. Internet J Surg 2006; 11(2): 14-8.
- Wella HL, Carneiro PMR. Children with acute abdomen requiring surgery at Muhimbili National Hospital Dar es Salaam. Tanzania Medical J 2011; 25(2).
- Wallace CA, Petrov MS, Soybel DI et al. Influence of imaging on the negative appendectomy rate in pregnancy. J Gastrointest Surg. 2008;12(1):46–50
- Wong CS. CT scan in acute surgical abdomen. Eur J Radiol 2012; 81: 22-26.
Corresponding Author
Dr Anwar Hussain
Registrar Department of Surgery, GMC Jammu, India
DOI: https://dx.doi.org/10.18535/jmscr/v9i1.12
