Abstract
The acute abdomen is characterized by the sudden onset of severe abdominal pain, which requires emergency medical or surgical consultation. It can be caused by diseases of any of the abdominal organs or organ systems, and, as such, the acute abdomen represents a physical condition rather than a disease. However, extra-abdominal disease may also lead cause an acute abdomen. A rapid and accurate diagnosis is essential because various potentially life-threatening processes may be the underlying causes of the physical complaints. Because of the wide spectrum of diseases that may cause an acute abdomen, the use of imaging techniques, in particular, multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), is often warranted because of their ability to suggest alternative diagnoses if the suspected clinical diagnosis is unconfirmed by ultrasonography (US). Depending on the clinical pattern and basic diagnosis, the treatment of such injuries requires a balance between the quick availability, the possible diagnostic benefit of additional and potential radiation exposures by imaging, possible time delay. These circumstances are particularly relevant for patients with life-threatening illnesses, when MDCT should be immediately be performed, and for pregnant woman when dedicated MRI can be a diagnostic option. Thus, early use of MDCT has been shown to reduce the number of serious diagnoses that are missed. Advanced diagnostics that may be used to guide and treat both trauma and non-trauma patients include such techniques as endoscopy or selective angiography, e.g., for the treatment of gastrointestinal or visceral organ hemorrhage. Parenchymateous organ or hollow organ visceral bleeding, including perforations, is representative of classical, life-threatening diagnoses secured by MDCT. However, advanced testing in patients that require surgery for abdominal emergencies will result in a delay in the necessary treatments. The present chapter defines the clinical context of patients presenting with an acute abdomen and provides information’s on clinical pattern and diagnostic strategies.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Aguirre DA, Santosa AC, Casola G, Sirlin CB (2005) Abdominal wall hernias: imaging features, complications, and diagnostic pitfalls at multi-detector row CT. Radiographics 25:1501–1520
Ambrosetti P, Becker C, Terrier F (2002) Colonic diverticulitis: impact of imaging on surgical management–a prospective study of 542 patients. Eur Radiol 12:1145–1149
American College of Surgeons—Committee on Trauma (2004) Initial assessment and management. In: ATLS advanced trauma life support—program for doctors, 7th edn. American College of Surgeons, Chicago, IL, pp 11–29
Andersson P, Söderholm JD (2009) Surgery in ulcerative colitis: indication and timing. Dig Dis 27:335–340
Angele MK, Khalil PN, Spelsberg F, Bruns CJ, Burges A, Jauch KW, Kleespies A (2011) Non-curable tumours of the female genital tract: therapeutic options in bowel stenosis and bleeding. Zentralbl Chir 136:237–243
Balthazar EJ (2002) Complications of acute pancreatitis: clinical and CT evaluation. Radiol Clin North Am 40:1211–1227
Boffard KD (2007) Surgical decision-making. In: Boffard KD (ed) Manual of definitive surgical trauma care, 2nd edn. Hodder Arnold, part of Hachette Livre, London, pp 47–64
Bortoff GA, Chen MY, Ott DJ, Wolfman NT, Routh WD (2000) Gallbladder stones: imaging and intervention. Radiographics 20:751–766
Cahir JG, Freeman AH, Courtney HM (2004) Multislice CT of the abdomen. Br J Radiol 77:64–73
de Dombal FT (1988) The OMGE acute abdominal pain survey. Progress report, 1986. Scand J Gastroenterol Suppl 144:35–42
Federle MP (2005) CT of the acute (emergency) abdomen. Eur Radiol 15(Suppl 4):D100–D104
Furukawa A, Sakoda M, Yamasaki M, Kono N, Tanaka T, Nitta N, Kanasaki S, Imoto K, Takahashi M, Murata K, Sakamoto T, Tani T (2005) Gastrointestinal tract perforation: CT diagnosis of presence, site, and cause. Abdom Imaging 30:524–534
Grafen FC, Neuhaus V, Schöb O, Turina M (2010) Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital. Langenbecks Arch Surg 395:57–63
Gralnek IM, Barkun AN, Bardou M (2008) Management of acute bleeding from a peptic ulcer. N Engl J Med 359:928–937
Green JM (2008) When is the faster better? Operative timing in acute care surgery. Curr opin Crit Care 14:423–427
Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR (2010) Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97:141–150
Hinchey EJ, Schaal PG, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109
Howell JM, Eddy OL, Lukens TW, Thiessen ME, Weingart SD, Decker WW (2010) Clinical policy: critical issues in the evaluation and manage-ment of emergency department patients with suspected appendicitis. Ann Emerg Med 55:71–116 American College of Emergency Physicians
Jacobs DO (2007) Clinical practice. Diverticulitis. N Engl J Med 357:2057–2066
Jaeckle T, Stuber G, Hoffmann MH, Freund W, Schmitz BL, Aschoff AJ (2008) Acute gastrointestinal bleeding: value of MDCT. Abdom Imaging 33:285–293
Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L (2005) Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg 92:44–49
Khalil PN, Huber-Wagner S, Ladurner R, Kleespies A, Siebeck M, Mutschler W, Hallfeldt K, Kanz KG (2009) Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis. Eur J Med Res 14:231–239
Khalil PN, Werner JC, Kleespies A (2010) Diagnostic of acute appendicitis in the emergency department. Notfall Rettungsmed 13:249–250
Khalil PN, Kleespies A, Angele MK, Thasler WE, Siebeck M, Bruns CJ, Mutschler W, Kanz KG (2011a) The formal requirements of algorithms and their implications in clinical medicine and quality management. Langenbecks Arch Surg 396:31–40
Khalil PN, Kleespies A, Angele MK, Bruns CJ, Siebeck M (2011b) Small bowel incarceration in recurrent perineal hernia after abdominoperineal resection. Int J Colorectal Dis 26:957–958
Kilpatrick CC, Monga M (2007) Approach to the acute abdomen in pregnancy. Obstet Gynecol Clin North Am 34:389–402
Kleespies A, Thasler WE, Schäfer C, Meimarakis G, Eichhorn ME, Bruns CJ, Jauch KW, Zügel N (2008) Acute pancreatitis: is there a need for surgery? Z Gastroenterol 46:790–798
Kool DR, Blickman JG (2007) Advanced Trauma Life Support. ABCDE from a radiological point of view. Emerg Radiol 14(3):135–141 Jul 2007
Laméris W, van Randen A, van Es HW, van Heesewijk JP, van Ramshorst B, Bouma WH, ten Hove W, van Leeuwen MS, van Keulen EM, Dijkgraaf MG, Bossuyt PM, Boermeester MA, Stoker J, MA OPTI (2009) Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ 338:b2431
Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP (2011) National trends in CT use in the emergency department: 1995–2007. Radiology 258:164–173
Leschka S, Alkadhi H, Wildermuth S, Marincek B (2005) Multi-detector computed tomography of acute abdomen. Eur Radiol 15:2435–2447
Lim HK, Bae SH, Seo GS (1992) Diagnosis of acute appendicitis in pregnant women: value of sonography. AJR Am J Roentgenol 159:539–542
Linsenmaier U, Wirth S, Reiser M, Körner M (2008) Diagnosis and classification of pancreatic and duodenal injuries in emergency radiology. Radiographics 28:1591–1602
Madoff DC, Denys A, Wallace MJ, Murthy R, Gupta S, Pillsbury EP, Ahrar K, Bessoud B, Hicks ME (2005) Splenic arterial interventions: anatomy, indications, technical considerations, and potential complications. Radiographics 25(Suppl 1):S191–S211
Malfertheiner P, Chan FK, McColl KE (2009) Peptic ulcer disease. Lancet 374(9699):1449–1461
Martin MJ, Steele SR (2010) Twists and turns: a practical approach to volvulus and intussusception. Scand J Surg 99:93–102
Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Shackford SR, Champion HR, McAninch JW (1995) Organ injury scaling. Surg Clin North Am 75:293–303
Myren J, Bouchier IA, Watkinson G, Softley A, Clamp SE, de Dombal FT (1988) The OMGE multinational inflammatory bowel disease survey 1976–1986. A further report on 3175 cases. Scand J Gastroenterol 144:11–19
Oniscu GC, Parks RW, Garden OJ (2006) Classification of liver and pancreatic trauma. HPB (Oxford) 8:4–9
Pachter HL, Guth AA, Hofstetter SR, Spencer FC (1998) Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg 227:708–717
Parks NA, Davis JW, Forman D, Lemaster D (2011) Observation for nonoperative management of blunt liver injuries: how long is long enough? J Trauma 70:626–629
Pringle JH (1908) Notes on the arrest of hepatic heorrhage due to trauma. Ann Surg 48:541–548
Renner P, Kienle K, Dahlke MH, Heiss P, Pfister K, Stroszczynski C, Piso P, Schlitt HJ (2011) Intestinal ischemia: current treatment concepts. Langenbecks Arch Surg 396:3–11
Rosen MP, Sands DZ, Longmaid HE 3rd, Reynolds KF, Wagner M, Raptopoulos V (2000) Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. AJR Am J Roentgenol 174:1391–1396
Rozycki GS, Tremblay L, Feliciano DV, Joseph R, DeDelva P, Salomone JP, Nicholas JM, Cava RA, Ansley JD, Ingram WL (2002) Three hundred consecutive emergent celiotomies in general surgery patients: influence of advanced diagnostic imaging techniques and procedures on diagnosis. Ann Surg 235:681–688
Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EA (2006) Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20:14–29
Schein M (2005a) The acute abdomen. In: Schein M, Rogers PN (eds) Schein’s common sense emergency abdominal surgery, 2nd edn. Springer, Berlin, pp 17–25
Schein M (2005b) Acute appendicitis. In: Schein M, Rogers PN (eds) Schein’s common sense emergency abdominal surgery, 2nd edn. Springer, Berlin, pp 245–254
Schick KS, Hüttl TP, Fertmann JM, Hornung HM, Jauch KW, Hoffmann JN (2008) A critical analysis of laparoscopic appendectomy: how experience with 1400 appendectomies allowed innovative treatment to become standard in a university hospital. World J Surg 32(7):1406–1413
Shakespear JS, Shaaban AM, Rezvani M (2010) CT findings of acute cholecystitis and its complications. AJR Am J Roentgenol 194:1523–1529
Shanley CJ, Weinberger JB (2008) Acute abdominal vascular emergencies. Med Clin North Am 92:627–647 ix
Silva AC, Pimenta M, Guimarães LS (2009) Small bowel obstruction: what to look for. Radiographics 29:423–439
Spencer SP, Power N, Reznek RH (2009) Multidetector computed tomography of the acute abdomen in the immunocompromised host: a pictorial review. Curr Probl Diagn Radiol 38:145–155
Stoker J, van Randen A, Laméris W, Boermeester MA (2009) Imaging patients with acute abdominal pain. Radiology 253:31–46
Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ (2006) Laparoscopic lysis of adhesions. World J Surg 30:535–540
Taourel P, Kessler N, Lesnik A, Pujol J, Morcos L, Bruel JM (2003) Helical CT of large bowel obstruction. Abdom Imaging 28:267–275
Trompetas V (2008) Emergency management of malignant acute left-sided colonic obstruction. Ann R Coll Surg Engl 90:181–186
Wang YR, Richter JE, Dempsey DT (2010) Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg 251:51–58
Yoon W, Jeong YY, Kim JK, Seo JJ, Lim HS, Shin SS, Kim JC, Jeong SW, Park JG, Kang HK (2005) CT in blunt liver trauma. Radiographics 25:87–104
Zech CJ, Reiser MF (2010) Acute abdomen: an interdisciplinary challenge. Radiologe 50:208
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Khalil, P.N. (2011). Acute Abdomen: Clinical Context and Indications for Imaging. In: Scaglione, M., Linsenmaier, U., Schueller, G. (eds) Emergency Radiology of the Abdomen. Medical Radiology(). Springer, Milano. https://doi.org/10.1007/174_2011_464
Download citation
DOI: https://doi.org/10.1007/174_2011_464
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-2512-7
Online ISBN: 978-88-470-2513-4
eBook Packages: MedicineMedicine (R0)