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What Causes of Chronic Abdominal Pain, Both Common and Uncommon, Should Be Considered and Investigated by the Emergency Medicine Provider?

  • Joseph Izzo
  • Janet Smereck
Chapter
First Online:

Abstract

Adult patients who present to the emergency department (ED) with chronic or recurrent abdominal pain pose many challenges in management and disposition for the emergency care provider. It is important to be aware of potentially life-threatening causes of chronic abdominal pain and consider commonly missed diagnoses which may be amenable to specific therapies. Chronically recurring abdominal pain is a symptom of many clinical entities. Functional or nonorganic disorders are diagnoses of exclusion. As with many chronic pain patients, frequent visits to the ED are often characteristic of opiate dependence and may complicate the search for undiagnosed but treatable conditions.

Keywords

Chronic abdominal pain Recurrent abdominal pain Functional gastrointestinal disorder 
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References

  1. 1.
    Zackowski S. Chronic recurrent abdominal pain. Emerg Med Clin North Am. 1998;16(4):877–94.CrossRefGoogle Scholar
  2. 2.
    Tack J, Talley N, Camilleri M, Holtmann G, Malagelada JR, Stanghellini V. Functional gastroduodenal disorders. Gastroenterol. 2006;130:1466–79.CrossRefGoogle Scholar
  3. 3.
    Cook L, Knight S, Junkins E, Mann NC, Dean JM, Olson LM. Repeat patients to the emergency department in a statewide database. Acad Emerg Med. 2004;11:256–63.CrossRefGoogle Scholar
  4. 4.
    Levine JS, Burakoff R. Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Hepatol. 2011;7(4):235–41.Google Scholar
  5. 5.
    Stein B, Everhart KK, Lacy BE. Gastroparesis: a review of current diagnosis and treatment options. J Clin Gastroenterol. 2015;49(7):550–8.CrossRefGoogle Scholar
  6. 6.
    Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127(5):1592–622.CrossRefGoogle Scholar
  7. 7.
    Soykan I, Sivri B, Sarosiek I, Kiernan B, McCallum RW. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci. 1998;43(11):2398–404.CrossRefGoogle Scholar
  8. 8.
    Bernardi MP, Warrier S, Lynch AC, Heriot AG. Acute and chronic pseudo-obstruction: a current update. ANZ J Surg. 2015;85(10):709–14.CrossRefGoogle Scholar
  9. 9.
    Wong YT, Brams DM, Munson L, Sanders L, Heiss F, Chase M, Birkett DH. Gastric outlet obstruction secondary to pancreatic cancer: surgical vs endoscopic palliation. Surg Endosc. 2002;16(2):310–2.CrossRefGoogle Scholar
  10. 10.
    Tendler DA. Malignant gastric outlet obstruction: bridging another divide. Am J Gastroenterol. 2002;97(1):4–6.CrossRefGoogle Scholar
  11. 11.
    Chowdhury A, Dhali GK, Banerjee PK. Etiology of gastric outlet obstruction. Amer J Gastroenterol. 1996;91(8):1679.Google Scholar
  12. 12.
    Barret M, Martineau C, Rahmi G, Pellerin O. Chronic mesenteric ischemia: a rare cause of chronic abdominal pain. Am J Med. 2015;128(12):1363.CrossRefGoogle Scholar
  13. 13.
    Kolkman JJ, Geelkerken RH. Diagnosis and treatment of chronic mesenteric ischemia: an update. Best Pract Res Clin Gastroenterol. 2017;31(1):49–57.CrossRefGoogle Scholar
  14. 14.
    Kallus SJ, Singhal P, Palese C, Smith JP, Haddad N. Median arcuate ligament syndrome: an unusual cause of chronic abdominal pain. Neuroenterology. 2016;4:235916, 6 pages. 10.4303/ne/235916.CrossRefGoogle Scholar
  15. 15.
    Hlnas JR, Gore RM, Ballantyne GH. Superior mesenteric artery syndrome: diagnostic criteria and therapeutic approaches. Am J Surg. 1984;148:4–6.Google Scholar
  16. 16.
    Farmer A, Saadeddin A, Holt CE, Bateman JM, Ahmed M, Syn WK. Portal vein thrombosis in the district general hospital: management and clinical outcomes. Eur J Gastroenterol Heopatol. 2009;21(5):517–21.CrossRefGoogle Scholar
  17. 17.
    Ahmed S, Shahid R, Russo L. Unusual causes of abdominal pain: sickle cell anemia. Best Pract Res Clin Gastroenterol. 2005;19(2):297–310.CrossRefGoogle Scholar
  18. 18.
    Ho CL. Wandering spleen with chronic torsion in a patient with thalassaemia. Singap Med J. 2014;55(12):2002–4.Google Scholar
  19. 19.
    Costanza C, Longstreth G, Liu A. Chronic abdominal wall pain: clinical features, health care costs and long term outcome. Gastroenterol. 2012;6(2):300–8.Google Scholar
  20. 20.
    van Assen T, Brouns J, Scheltinga MR, Roumen RM. Incidence of abdominal pain due to the anterior cutaneous nerve entrapment syndrome in an emergency department. Scand J Trauma Resusc Emerg Med. 2015;23(19):1–6.Google Scholar
  21. 21.
    Oor JE, Ünlü Ç, Hazebroek EJ. A systematic review of the treatment for abdominal cutaneous nerve entrapment syndrome. Am J Surg. 2016;212(1):165–74.CrossRefGoogle Scholar
  22. 22.
    Thome J, Egeler C. Abdominal cutaneous nerve entrapment syndrome (ACNES) in a patient with a pain syndrome previously assumed to be of psychiatric origin. World J Biol Psychiatry. 2006;7(2):116–8.CrossRefGoogle Scholar
  23. 23.
    Loos MJ, Scheltinga MR, Mulders LG. The Pfannenstiel incision as a source of chronic pain. Gynecologie. 2008;111(4):839–46.CrossRefGoogle Scholar
  24. 24.
    Herrick A, McColl K. Acute intermittent porphyria. Best Pract Res Clin Gastroenterol. 2005;19(2):235–49.CrossRefGoogle Scholar
  25. 25.
    Karim Z, Lyoumi S, Nicolas G, Deybach JC, Gouya L, Puy H. Porphyrias: a 2015 update. Clin Res Hepatol Gastroenterol. 2015;39(4):412–25.CrossRefGoogle Scholar
  26. 26.
    Liu Y, Lien W, Fang C, Lai TI, Chen WJ, Wang HP. ED presentation of acute porphyria. Am J Emerg Med. 2005;23:164–7.CrossRefGoogle Scholar
  27. 27.
    Tsai M, Huang S, Cheng S. Lead poisoning can be easily misdiagnosed as acute porphyria and nonspecific abdominal pain. Case Rep Emerg Med. 2017;9050713, 4 pages. Accessed online 01/19/2018.Google Scholar
  28. 28.
    Shah S, Gaffney R, Dykes T, Goldstein J. Chronic appendicitis: an often forgotten cause of recurrent abdominal pain. Am J Med. 2013;126:e7–8.CrossRefGoogle Scholar
  29. 29.
    Yuan S, Tager S. Acute onset of chronic aortic dissection presenting as abdominal pain. Kardiol Pol. 2009;67(2):168–71.PubMedGoogle Scholar
  30. 30.
    Zelivianskaia A, Boddu P, Samee M. Chronic abdominal pain from inferior vena cava filter strut perforation: a case report. Am J Med. 2016;129(3):e5–7.CrossRefGoogle Scholar
  31. 31.
    Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015;313(9):949–58.CrossRefGoogle Scholar
  32. 32.
    Kellow JE. A practical evidence-based approach to the diagnosis of the functional gastrointestinal disorders. Am J Gastroenterol. 2010;105(4):743–6.CrossRefGoogle Scholar
  33. 33.
    Schmulson MJ, Drossman DA. What is new in Rome IV. J Neurogastroenterol Motil. 2017;23(2):151–63.CrossRefGoogle Scholar
  34. 34.
    Grover C, Wielo E, Close RJ. Narcotic bowel syndrome. J Emerg Med. 2012;43(6):992–5.CrossRefGoogle Scholar
  35. 35.
    Drossman D. Abuse, trauma and GI illness: is there a link? Am J Gastroenterol. 2011;106(1):14–25.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Joseph Izzo
    • 1
  • Janet Smereck
    • 1
  1. 1.Department of Emergency MedicineMedStar Georgetown University HospitalWashington, DCUSA

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