Acute Abdomen

Acute Abdomen – Treatment Options

Introduction
An acute abdomen refers to the sudden onset of severe abdominal pain requiring urgent evaluation, as it may indicate a life-threatening intra-abdominal condition. Causes range from surgical emergencies (appendicitis, perforated peptic ulcer, bowel obstruction, ruptured ectopic pregnancy) to medical conditions (pancreatitis, mesenteric ischemia, gastroenteritis). Prompt recognition, stabilization, and timely intervention are critical to reducing morbidity and mortality.

1. Immediate Stabilization

• Airway, breathing, circulation (ABC): Initial resuscitation with oxygen and IV access.

• Intravenous fluids: Crystalloids to correct hypovolemia and maintain hemodynamic stability.

• Analgesia: IV opioids for pain relief; contrary to older practice, analgesia does not obscure diagnosis.

• Monitoring: Vital signs, urine output, and mental status for early detection of shock or sepsis.

2. Diagnostic Evaluation (Parallel to Stabilization)

• Laboratory tests: CBC, electrolytes, renal function, liver enzymes, lipase/amylase, pregnancy test in women of childbearing age.

• Imaging:

  • Ultrasound: First-line for biliary disease, gynecological pathology, free fluid.

  • CT abdomen and pelvis: Gold standard in most cases; identifies appendicitis, perforation, obstruction, ischemia.

  • Plain X-rays: Useful for bowel obstruction, perforation (free air).

3. Medical Management

• Antibiotics: Broad-spectrum coverage (e.g., piperacillin–tazobactam, ceftriaxone + metronidazole, or carbapenems) when infection or perforation is suspected.

• Proton pump inhibitors (PPIs): For suspected perforated peptic ulcer or upper GI bleeding.

• Antiemetics: Ondansetron or metoclopramide for nausea/vomiting.

• Blood transfusion: For hemorrhagic causes or severe anemia.

4. Surgical and Interventional Management

• Appendicitis: Laparoscopic appendectomy (gold standard); conservative antibiotic therapy in select cases.

• Perforated viscus: Emergency laparotomy or laparoscopic repair.

• Bowel obstruction:

  • Conservative management (nasogastric decompression, fluids) in partial obstruction.

  • Surgery for complete obstruction, strangulation, or perforation.

• Ectopic pregnancy rupture: Emergency surgery (salpingectomy/salpingostomy).

• Mesenteric ischemia: Revascularization procedures or bowel resection if infarction present.

• Cholecystitis/Cholangitis: Early laparoscopic cholecystectomy or endoscopic retrograde cholangiopancreatography (ERCP).

5. Supportive and Preventive Measures

• Nil per os (NPO): To reduce aspiration risk and prepare for possible surgery.

• Nasogastric tube: For decompression in bowel obstruction or ileus.

• Venous thromboembolism prophylaxis: In hospitalized patients awaiting surgery.

• Postoperative care: Pain management, early mobilization, and infection prevention.

6. Multidisciplinary Care

• Surgeons: For definitive operative management.

• Radiologists: For prompt imaging interpretation.

• Intensivists: For unstable patients requiring ICU support.

• Gynecologists: For acute pelvic causes (ectopic pregnancy, ovarian torsion).