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Nonspecific Abdominal Pain

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Emergency Laparoscopy

Abstract

Five to ten percent of all admissions to the emergency department (ED) are due to acute abdominal pain. Acute nonspecific abdominal pain (NSAP) is defined as acute abdominal pain less than one week in duration, for which there is no diagnosis despite investigations and comprises a spectrum of undiagnosed conditions, both somatic and functional, and remains a “diagnosis of exclusion.”

The necessity to achieve a correct diagnosis and a systematic approach to NSAP should be useful in order to reduce the admission rate for NSAP because of the costs and morbidity associated with this condition in terms of excessive hospital stay, multiple investigations, and unnecessary surgical explorations.

Systematic baseline characters examination, abdominal ultrasound (US) abdominal computed tomography (CT), and early laparoscopy (EL) have all been described as potential methods for improving the diagnostic accuracy in the emergency setting.

In conclusion, the management of acute NSAP can be divided into three stages. The first stage is the initial history, physical examination, baseline investigations, and formulation of a working and differential diagnosis. The second stage involves the judicious use of radiologic techniques.

The third stage should be represented by diagnostic laparoscopy. Enhanced or non-enhanced computed tomography of the abdomen and pelvis is a crucial step, after baseline examination and before invasive diagnostic methods such as diagnostic laparoscopy.

Diagnostic laparoscopy is helpful in treatment of patients with NSAP because it improves the achievement of correct diagnosis and reduces hospital stay and per-patient costs although seems to be unuseful in prevention of recurrence of symptoms.

The results of our systematic review suggest that there is insufficient evidence at present to justify routine use of early laparoscopy in patients with undifferentiated acute abdominal pain. For this reason, laparoscopy should be reserved to patients with worsening course or when urgency is reasonably suspected after baseline.

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Authors and Affiliations

  1. IRCCS Ospedale San Raffaele, Milan, Italy

    Michele Carlucci, Aldo Alberto Beneduce, Guido Fiorentini & Giovanni Burtulo

Authors
  1. Michele Carlucci
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  2. Aldo Alberto Beneduce
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  3. Guido Fiorentini
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  4. Giovanni Burtulo
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Corresponding author

Correspondence to Michele Carlucci .

Editor information

Editors and Affiliations

  1. Department of General Surgery, Azienda ULSS19 del Veneto, Adria, Italy

    Ferdinando Agresta

  2. AUSL Viterbo, Ospedale San Giovanni Decollato Andosill, Civita Castellana, Italy

    Fabio Cesare Campanile

  3. Dept of Morfology, Surgery and Experime, School of Medicine, Univ of Ferrara, Ferrara, Italy

    Gabriele Anania

  4. Careggi University Hospital, Florence, Italy

    Carlo Bergamini

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Carlucci, M., Beneduce, A.A., Fiorentini, G., Burtulo, G. (2016). Nonspecific Abdominal Pain. In: Agresta, F., Campanile, F., Anania, G., Bergamini, C. (eds) Emergency Laparoscopy. Springer, Cham. https://doi.org/10.1007/978-3-319-29620-3_6

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  • DOI: https://doi.org/10.1007/978-3-319-29620-3_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29618-0

  • Online ISBN: 978-3-319-29620-3

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