Acute Abdomen: Violent abdominal pain as the main symptom

Sudden violent abdominal pain and a brittle belly are among the leading symptoms in an acute abdomen. "Abdomen" is the medical term for "stomach, abdomen". It is a medical emergency situation that must be treated immediately by the specialist. The abdomen is not an independent disease. Behind the sudden, severe pain in the stomach are various, sometimes life-threatening causes. In this article, you will learn which typical symptoms indicate an acute abdomen, what causes it, and what you should do right away.

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The most common symptom of acute abdominal pain in almost all patients are severe to very severe abdominal pain of various severity. Patients complain, for example, of upper abdominal pain, lower abdominal pain or abdominal cramps. In some, the pain swells up and down like a colic, while in others the pain is permanent. In addition, depending on the underlying disease, they suffer from accompanying vegetative symptoms such as nausea, bowel movement disorders (peristaltic disorders ), vomiting , fever , paleness, cold sweats and restlessness.

As a trigger for the symptoms of an acute abdomen can be a variety of diseases of the organs in the abdominal cavity (abdominal cavity) or in the adjacent chest. Some of the potential causes are acutely life threatening. The extent and intensity of the pain does not necessarily indicate the severity of the underlying disease. For this reason, it is important to clarify the causes of abdominal cramping quickly.
If you suffer from an acute abdomen, you need quick medical help. Affected patients should be hospitalized immediately. Interdisciplinary internists and surgeons usually clarify which causes underlie the symptoms.

What symptoms speak for an acute abdomen?

The sudden or acute abdomen is not an independent disease. Rather, it is a conditional description in which one or more of the following guiding symptoms occur.

Key symptoms for the acute abdomen

  • Severe to strongest abdominal pain that is sudden or slow (abdominal pain, upper abdomen, lower abdomen, abdominal cramps)
  • Touch sensitivity of the abdominal wall / defense tension of the abdominal wall
  • Disruption of normal gastrointestinal activity: nausea, vomiting, diarrhea , stool condition
  • Circulatory disorder up to shock
Depending on the cause, the pain is dull, stinging or spasmodic (colicky). In inflammatory processes they usually increase slowly. In perforations (from Latin "perforare" = "piercing") and injuries, the pain usually occurs suddenly and violently. Colic-like pain is typical for the closure of a hollow organ (intestinal obstruction, kidney stones and the like).
The localization of the pain is often possible only at the beginning of the disease. Over time, the pain radiates increasingly throughout the body. In most cases, the peritoneum is very irritated. This manifests itself in the so-called defense tension. The belly seems tight and is extremely sensitive to touch and pressure. Depending on the cause it comes to bowel movement disorders, which manifest themselves either by Stuhlverhalt or diarrhea. In some cases, nausea and vomiting also occur.

To the hospital accompanied by a doctor

Especially in the elderly and toddlers, the disease is often obscured because the perception of pain or the means of expression are limited. Pain can not always be interpreted as a measure of the danger of the underlying diseases. Especially as, for example, internal bleeding is not always associated with pain. In this case, cold sweats, paleness and dizziness are often the first symptoms due to lack of blood volume.
In particularly severe cases it comes in a very short time to shock symptoms. Due to possible rapid onset of complications, those affected should always be transported to the hospital with a doctor.

Causes of the acute abdomen

The list of all diseases that can lead to the symptom complex of the acute abdomen is very long. In most cases, however, the causes are either due to inflammatory processes, direct injuries, mechanical effects or bleeding or circulation problems.
In addition to these triggers, there are a variety of other diseases that can lead to the symptom complex of the disease, although they do not affect the abdominal cavity itself. These include, for example, heart attacks or herniated discs. Statistically, in the under-50s age group, appendicitis (32 percent) and gallbladder inflammation (21 percent) in the over-50s age group are the most common cause.
These are the different causes of the painful symptoms:


Inflammation in the individual abdominal organs can lead to damage to the organ wall, break it (perforate) and thus pass into the abdominal cavity. The consequences are a life-threatening peritonitis (peritonitis) and usually an intestinal obstruction (paralytic ileus due to a paralysis of the intestinal musculature). Both conditions lead to an acute abdomen with severe abdominal pain. A special case is the pancreatitis. In pancreatitis, digestive enzymes leak, causing damage to surrounding structures.
These inflammatory diseases trigger an acute abdomen:
  • Appendicitis (appendicitis)
  • Broken stomach or small intestine ulcer
  • diverticulitis
  • Acute gallbladder inflammation (cholecystitis)
  • Acute pancreatitis ( pancreatitis )
  • tubal inflammation
  • Perforation of a fallopian tube or peritoneal pregnancy (extrauterine pregnancy) with subsequent inflammation

Direct injuries

Professionals distinguish two forms of injury:
  • Closed (blunt) abdominal injuries
  • Open (perforating) abdominal injuries
An injury-induced acute abdomen occurs when external force on the abdominal wall has caused an injury to the abdominal organs. The blood exiting the abdominal cavity acts like a foreign body on the organism and provides the corresponding symptoms. In addition, the heavy blood loss can lead to a volume-loss shock. In addition to blood, organ contents such as gastrointestinal contents may also enter the abdominal cavity and additionally cause inflammation of the peritoneum (peritonitis).

Mechanical effects on the stomach

Mechanical causes in the abdomen can lead to intestinal obstruction (so-called mechanical ileus), which is always accompanied by acute abdominal pain. Common causes for this are:
  • tumors
  • Intestinal breaks (hernias)
  • diverticulitis
  • Crohn's disease
  • foreign body
  • faecal stones
  • adhesions

Bleeding in the abdominal area

Bleeding is basically possible on all organs in the abdomen. Free blood in the abdominal cavity acts on the organism like a foreign body and therefore triggers the painful symptoms. At least as serious is the blood loss as such, which can lead to a shock due to the lack of blood volume.
The most common causes of bleeding are external injuries, for example as a result of a traffic accident. Even untreated stomach or duodenal ulcer erupting through the organ wall causes bleeding. In addition, there may be a massive hemorrhage in the abdomen when a congenital or acquired Ausackung the wall of the great abdominal aorta (ruptured aortic aneurysm) ruptures.

Sudden onset of circulatory disorders

Sometimes pathological blood vessels also lead to an acute abdomen. This includes:
  • Vascular occlusions (for example by vascular calcification)
  • Thrombosis of the blood vessels
  • Lack of blood supply to a region or organ through a wall lining of the major aorta of the abdomen.
One consequence of this is, for example, the so-called mesenteric infarction. It causes parts of the digestive tract to die down to the entire organ by occluding the supplying blood vessels.

How is an acute abdomen diagnosed?

The acute abdomen is a medical emergency. Therefore, it is important to first identify the causes of the complaints. The anamnesis includes the following steps:

  • a medical survey
  • a physical examination
  • blood tests
  • Ultrasound and / or computed tomography of the abdominal cavity
  • if necessary X-ray of abdominal and thoracic cavity
In order to be able to make a reliable diagnosis, the doctor takes into account the history of the disease and the findings of the physical examination. As a patient or relative, you provide important information by describing the course of the disease. A criterion is also whether the patient has visited the practice or the clinic independently or whether he was admitted by ambulance.
During the physical examination of the patient lying down, the doctor determines whether the abdominal wall is taut and sensitive to pressure. This gives him clues to peritoneal irritation or inflammation. With the stethoscope he hears whether the intestine still makes noises or whether the intestine has stopped its activity due to serious disturbances in the abdomen. Just as important is the control of heart rate, blood pressure, breathing and body temperature to get an overall picture of the condition of the patient.

Examination of the rectum (rectal blanking)

The palpation of the rectum with the finger completes the medical examination. In doing so, the physician feels bottlenecks or tumors (tumors). Bleeding in the lower digestive tract, he sees blood on the gloved finger. The absence of bowel movements on the finger can be an important indicator of passage disturbances (suspicious for bowel obstruction).
By taking the medical history and the physical examination, the doctor usually recognizes what further equipment tests are necessary.

blood test

Certain blood tests also give useful hints on the origin of the disease. To be examined
  • the number of red and white blood cells 
  • Inflammation marker (such as erythrocyte sedimentation rate or CRP)
  • Blood sugar as well as liver, kidney and electrolyte values ​​(for example sodium, potassium)
Depending on the suspected cause, the doctor also determines enzymes (proteins) of the pancreas and coagulation factors. Women of childbearing potential should also have a pregnancy test.


In addition to the diagnostic in most cases also includes an ultrasound examination of the abdominal cavity. With this examination method, the doctor also looks for free fluid in the abdomen. These may be, for example, blood and pus, but also tissue fluid (serous fluid) released by inflammation. At the same time, the doctor examines the individual organs: Contour, tissue or surface changes indicate any injuries or illnesses (for example splitting of the spleen).


In addition to the ultrasound examination, the doctor also decides in some cases to x-ray the lungs and abdomen (thorax and abdomen). On the basis of the X-ray images of the doctor recognizes, for example, foreign bodies, feces or free air, which are an indication that airborne hollow organs (for example, stomach or intestine) may be injured.

Computed Tomography

Computed tomography (CT) also allows free air to be displayed in the abdominal cavity. Thanks to the fast and high-resolution computed tomography available today, it is also possible to check suspected diagnoses or detect possible complications at an early stage. Not infrequently, the doctor also finds causes of the acute abdomen, which he had not previously thought of, with this method and can thus broaden his therapy decisions. CT is therefore used more and more frequently in acute abdominal diagnosis.


Sometimes, the doctor also causes a laparoscopy to come to a clear diagnosis. This procedure, also known as keyhole surgery, gives you general anesthesia. Using a cannula underneath the navel, the doctor injects carbon dioxide gas into the abdominal cavity - thus he sees better and creates more space in the abdominal cavity and thus more room for maneuver.
Subsequently, the surgeon - also in the region of the navel - via a sleeve (trocar) introduces an optic, through which he gets an overview of the conditions in the abdominal cavity (abdominal cavity). So he inspects the entire abdomen, paying particular attention to the organs, which he knows are often the cause of an acute abdomen, such as the appendix (appendicitis).

What therapeutic measures help with acute abdomen?

The aim of the treatment of the complaints is to stabilize the vital functions of the organism (for example, breathing and heart function) and to eliminate the cause of the complaints. Depending on the findings, the doctor decides on a therapy, for example, for an operation. This may also lead to a temporary impairment of quality of life - perhaps because of an artificial intestinal output.
If the doctor fails to make a confirmed diagnosis using the usual procedures and the condition of the patient deteriorates, he or she will decide in favor of an emergency operation if in doubt.
Basically, an acute abdomen can be based on both diseases that require immediate surgery and diseases that require only conservative, non-surgical treatment.

Surgery for surgical conditions

If abdominal surgery is necessary, there are two procedures depending on the severity of the disease:
  • Opening of the abdominal cavity (laparotomy)
The surgeon usually opens the abdomen with a so-called midline (median laparotomy), where he cuts in the midline of the abdomen, usually around the left navel. Depending on the findings, for example, it removes an inflamed gallbladder, clears any accumulations of abscesses , sews or removes - if possible - injured organs (for example, the spleen) and stops bleeding.
  • Laparoscopic surgery
The laparoscopy or so-called keyhole surgery not only serves the diagnosis, specialists also use it therapeutically. For example, they solve or eliminate easily accessible adhesion strands between the intestinal loops (bridles), which hinder the intestinal movement.
In the case of mechanical intestinal obstruction and pronounced inflammation in the abdomen, however, the laparoscopy can only be used to a limited extent. For the cause of the intestinal obstruction can usually not be remedied laparoscopically. The risk is that inflamed intestinal tissue is injured by the inserted pods and instruments.

Treatment for non-surgical conditions

There are numerous diseases that cause severe abdominal pain and have no cause that can be repaired surgically. In these cases, you better look for a specialist. Which specialist can help you depends on the symptoms. These diseases are typical for acute abdomen:
  • Ureteral stones: treatment by urologists
  • Fallopian tube inflammations: treatment by gynecologists
  • Pneumonia: treatment in internal medicine / pneumology
  • Heart posterior infarcts: treatment in internal medicine / cardiology
  • Derailment of diabetes (diabetes mellitus): treatment in internal medicine / diabetology

Can I prevent an acute abdomen?

There are no effective preventive measures against appendicitis or injuries. However, if you have diabetes , you should make sure that it is well-adjusted and monitored by a doctor. Likewise, you can prevent an acute abdomen, heart disease and obesity through a healthy lifestyle with balanced nutrition and adequate exercise.

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