The acute abdomen - a surgical emergency

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An acute abdomen is a surgical emergency in which the patient must be seen urgently by a doctor - DON'T WASTE TIME WITH THIS WEBSITE TRYING TO DO IT YOURSELF! GET MEDICAL HELP.

An acute abdomen is indicated by severe constant abdominal pain, sometimes with colicky exacerbations during which the patient is obviously ill, distressed and often frightened.

An acute abdomen should always been considered with any bowel symptom. The early warning symptoms are often the same as for milder problems.

Suspect an acute abdomen if:

  • The symptoms are severe and unremitting (i.e. they don't go away)
  • The symptoms are getting progressively worse
  • The patient lies very still and dare not move because of pain (I often used to ask my children with tummy pain if they can hop on one leg without pain: if they can, it makes appendicitis unlikely)
  • There is blood in the vomit, stool, urine or in vaginal discharge
  • Urine goes brown (early sign of jaundice)
  • There is systemic upset, such as shock (low blood pressure, fast heart rate, shortness of breath, fever)
  • The patient feels ill, does not want to eat or drink, often vomits
  • There is severe colic. Colic is a pain which comes and goes in a "wave". Once experienced, never forgotten!
  • The patient is frightened

Common causes of acute abdomen

There may be several causes, with a further array of symptoms:


Starts with central colicky pain which settles in the right lower tummy, usually there is one vomit, loss of appetite, perhaps diarrhoea, slight temperature.

Ectopic pregnancy

Lower tummy pain, late period, sometimes vaginal discharge. Sometimes there is pain in the shoulder - this is a referred pain.

Bowel obstruction

Colicky pain, wind, gas, bloating, nausea, vomiting, constipation and sometimes no farting (Examples: cancer, hernia, after an operation)


Sudden onset of severe abdominal pain. The patient knows something nasty has happened. Systemic upset.(Examples: ulcer, diverticulitis, cancer)


Same as appendicitis but usually on the left side of the tummy - (a "left sided appendicitis"). See Diverticulitis - a cause of lower abdominal pain

Bleeding ulcer

Blood either vomited (often looks like black flecks or coffee grounds) or passed in the motion as a black, sticky, foul smelling stool.

Testicular torsion

Confusing because there may be no pain in the testicle but pain in the tummy. The testicle may be a bit tender and high in the scrotum.

Gall bladder disease

Colicky pain under the right ribs radiating round to the back, painful to touch, with vomiting, sometimes dark urine and pale stools.(Examples: cholecystitis, gall stones) See Gall bladder disease and gall stones


(See Pancreatitis - often a forgotten diagnosis)

A nasty central abdominal pain radiating through to the back. Painful to lie down, easier to sit up or lean forwards.


This refers to blood supply cut off. Sudden onset of severe abdominal pain. Often there are other arterial problems such as angina.

Inflammatory bowel disease

Crohn's disease or ulcerative colitis. See Crohn's disease and ulcerative colitis - inflammatory bowel disease responds well to the environmental approach

Pelvic inflammatory disease

i.e. infection of the womb. Lower abdominal pain, fever, sometimes vaginal discharge. See Pelvic Inflammatory Disease

Kidney stones

Classically causes a very severe loin to groin pain, desire to pee, possibly blood in the urine. See Kidney stones - a cause of serious pain

Acute urinary retention

No doubt about this diagnosis: severe pain but can't pee.

Kidney infections

Are often very painful. Kidney pain is in the back behind the lower ribs - so called "loin".

Labour pains

All doctors get caught out by this at some stage in their career!

Aortic aneurysm

AND... other things which I have forgotten!


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