Acute abdomen: causes, symptoms, diagnosis, exploratory laparotomy, therapies

By Cristiano Antonino On Jun 7, 2023

Acute abdomen (in English “acute abdomen”) is a clinical picture with sudden and violent onset, characterized by very intense pain that appears in the abdomen in a specific or widespread point

The causes can be different and more or less serious.

In some cases, the underlying disease that causes an acute abdomen is very serious, such as to require or suggest surgical treatment, in the absence of which the patient could even die.

Possible intraperitoneal causes of acute abdomen are

Peritoneal inflammation: chemical (peptic ulcer perforation, ovarian cyst rupture, Graafian follicle rupture); bacterial, usually secondary to perforation of hollow viscera;
Intestinal inflammation (Meckel’s diverticulitis, amoebic-bacterial colitis, diverticulitis);
Inflammatory processes of solid viscera (pancreatitis, pancreatic, splenic, hepatic abscess), of pelvic structures (salpingitis, tubo-ovarian abscess, endometritis), of mesenteric structures (bacterial, viral lymphadenitis, epiploic appendicitis); 4) Acute hollow viscera occlusion/distension;
Torsions (omental torsions, torsion/degeneration of fibroids in pregnancy);
Hemoperitoneum (ectopic pregnancy, ruptured aortic aneurysm, splenic/liver rupture);
Ischemia (mesenteric thrombosis, splenic, hepatic infarction, omentum ischemia); 8) Neoplasms;
Closed, open, iatrogenic traumas.

Possible extraperitoneal causes of acute abdomen are

Genitourinary (excretory tract lithiasis, pyelonephritis, abscess, perineal infarction, prostatitis, vesiculitis, epididymitis, testicular torsion, threatened miscarriage);
Pulmonary (pneumonia, empyema, pulmonary embolism, infarction, pneumothorax);
Cardiac (ischemia/infarction, acute pericarditis);
Metabolic (acute intermittent porphyria, familial Mediterranean fever, hypolipoproteinemia, hemochromatosis, hereditary angioneurotic edema);
Endocrine (diabetic ketoacidosis, hyperparathyroidism, hyperthyroidism/hypothyroidism, acute adrenal insufficiency);
Musculoskeletal (thoracolumbar arthritis/discopathy, rectus muscle hematoma);
Neurogenic (abdominal epilepsy, tabes dorsalis, Herpes zoster, bone marrow osteomyelitis, multiple sclerosis);
Inflammatory (systemic lupus erythematosus, panarteritis nodosa, dermatomyositis, scleroderma, Schönlein-Henoch purpura);
Infectious (bacterial, parasitic, malaria; viral: measles, mumps, mononucleosis);
Haematological (acute leukemia, acute haemolytic state, acute sickle cell disease);
Toxic (bacterial/fungal toxins, animal poisons, cyanide, drugs, arsenic);
Retroperitoneal (spontaneous adrenal hemorrhages).

Symptoms and signs of acute abdomen

Depending on the cause, the symptoms and signs associated with acute abdomen can be different, but generally consist of:

abdominal pain (spontaneous, palpable, visceral, somatic or referred);
wall reaction (localized or diffuse);
peristalsis disturbances (increase, total or localized arrest);
nausea;
vomit;
fever;
tachycardia;
arterial hypotension;
contraction of diuresis;
shock;
symptoms and signs of digestive bleeding.

Diagnosis

Diagnostic tests include blood and urine tests; blood tests; radiographs, including supine and standing views; IV urography; ultrasound; CT and arteriography.

Each test has specific indications based on the type of disease present.

However, the most important diagnostic measure in patients with severe abdominal pain is often prompt exploratory laparotomy.

Indications for indicative laparoscopy

Prompt exploratory laparotomy is indicated in case of:

abdominal distention and stiffness;
abdominal masses with fever or septic state;
uncontrollable bleeding;
suspected mesenteric infarction;
bowel obstruction;
radiographic or clinical signs of perforation;
leukocytosis (>18,000 GB mm).

Pharmacological therapy

In the case of an acute abdomen, the fundamental therapeutic choice is between surgical therapy and conservative therapy.

Each acute abdomen has its own characteristics and the treatment is designed according to the underlying cause

In the most severe cases, the timing of the surgery is a decisive factor for the survival of the patient.

The observation of the patient, the diagnostic hypothesis, the instrumental verification tests, the control of the vital parameters and the possible correction of the parameters, must take place simultaneously.

In some cases, the operation can be performed with deferred urgency, preceded by a more detailed diagnostic picture and possible attempts at conservative resolution.

For patient hydration: continuous infusion; glucose solution 10% 1000 ml/day; polysaline solution 1000-1500 ml/day. For antibiotic coverage: Plander 500 ml in drip; Ciproxin 200 mg i.v. every 12 hours.

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