Acute abdomen

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Acute abdomen refers to a sudden, severe pain in the abdomen that is less than 24 hours in duration. It is in many cases an emergency condition requiring urgent and specific diagnosis, and the treatment usually involves surgery.

Classification

Peritonitis

Acute abdomen is occasionally used synonymously with peritonitis. This is not incorrect; however, peritonitis is the more specific term, referring to inflammation of the peritoneum. It is diagnosed on physical examination as rebound tenderness, or pain upon removal of pressure rather than application of pressure to the abdomen. Peritonitis may result from several diseases, notably appendicitis and pancreatitis.

Ischemic Acute abdomen

Vascular disorders are more likely to affect the small bowel than the large bowel. Arterial supply to the intestines is provided by the superior and inferior mesenteric arteries, (SMA and IMA respectively) both of which are direct branches of the aorta.

The superior mesenteric artery supplies:

  1. Small bowel
  2. Ascending and proximal 2/3 of the transverse colon

The inferior mesenteric artery supplies:

  1. Distal 1/3 of the transverse colon
  2. Descending colon
  3. Sigmoid colon

Of note, the splenic flexure, or the junction between the transverse and descending colon, is supplied by the most distal portions of both the inferior mesenteric artery and superior mesenteric artery. It is referred to medically as a watershed area, or an area especially vulnerable to ischemia during periods of systemic hypoperfusion, such as in shock (medical).

Acute abdomen of the ischemic variety is usually due to:

  1. A thromboembolism from the left side of the heart, such as may be generated during atrial fibrillation, occluding the SMA.
  2. Nonocclusive ischemia, such as that seen in hypotension secondary to heart failure may also contribute, but usually results in a mucosal or mural infarct, as contrasted with the typically transmural infarct seen in thromboembolus of the SMA.
  3. Primary mesenteric vein thromboses may also cause ischemic acute abdomen, usually precipitated by hypercoagulable states such as polycythemia vera.

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Clomifene
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Diagnosis

History and Symptoms

Patients with an Ischemic type of acute abdomen present with symptoms of:

Physical Examination

Abdomen

In cases of ischemic acute abdomen, bowel sounds will be absent.

Laboratory Findings

In cases of ischemic acute abdomen, laboratory tests reveal:

CT

A CT scan can provide a differential diagnosis between simple and complex pathologies causing the Acute abdomen. The scan can also provide evidence to the doctor whether surgical intervention is necessary.

Other Imaging Findings

In cases of ischemic acute abdomen, abdominal radiography will show many air-fluid levels, as well as widespread edema.

Treatment

Surgery

Acute ischemic abdomen is a surgical emergency. Typically, treatment involves removal of the region of the bowel that has undergone infarction, and subsequent anastomosis of the remaining healthy tissue.

References


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