Acute Abdomen

The term 'acute abdomen' represents a rapid onset of severe symptoms that may indicate lifethreatening intra-abdominal pathology. Pain is usually a feature but is not always the case. A pain-free acute abdomen is more likely in the elderly, in children and in the third trimester of pregnancy. [1] The differential diagnosis is extremely wide and definitive diagnosis is often difficult, particularly in primary care. This is due to the many different organs within the peritoneal cavity and the potential for referred pain. Abdominal pain is a common problem, ranking in the top three symptoms of patients presenting to accident and emergency departments, but only a few of those patients will have an acute abdomen. Management of the acute abdomen in primary care should focus on careful assessment to reach a differential diagnosis list, with close attention paid to symptoms and signs that may indicate a need to investigate the situation further in hospital. The clinical scenario can change rapidly and conclusions previously reached by you or your colleagues may need to be revised as events evolve. A failure to be open-minded and revise a previous diagnosis is often at the heart of medicolegal claims relating to patients with an acute abdomen. [1] This article will concentrate on diagnosing the important causes of the acute abdomen in primary care/emergency department settings.