Acute Abdomen: Violent abdominal pain as the main symptom


Sudden violent abdominal pain and a hard belly are among the leading symptoms in an acute abdomen. It is a medical emergency situation that needs immediate attention.

The most common symptom of acute abdominal pain in almost all patients are severe to very severe abdominal pain of various severity. For example, sufferers complain of upper abdominal pain, lower abdominal pain or abdominal cramps. In some, the pain swells up and down like a colic, while in others it stops without interruption. 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. Patients should be hospitalized immediately. Interdisciplinary internists and surgeons usually clarify which causes underlie the complaints.

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 in acute abdomen

  • Severe to severe abdominal pain that is sudden or slow (pain in 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. Also, because, 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 blood volume depletion.

In particularly severe cases, it comes in a very short time to shock symptoms. Due to possible rapid onset of complications, patients should always be transported to the hospital with a doctor.

Causes of the acute abdomen

In most cases, however, the causes are either due to inflammatory processes, direct injuries, mechanical effects or bleeding or circulatory problems.

In addition to these triggers, there are a variety of other diseases that can lead to the symptom complex of the acute abdomen, 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.

The following causes are eligible for the painful symptoms:


Inflammation in abdominal organs can cause damage to the organ wall, break it (perforate) and so 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 muscles). Both conditions lead to an acute abdomen with severe abdominal pain. A special case is the pancreatitis. In pancreatitis, digestive enzymes escape, 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 injuries:

  • Closed (blunt) abdominal injuries
  • Open (perforating) abdominal injuries

An injury-induced acute abdomen occurs when external force on the abdominal wall causes injury to the abdominal organs. The blood exiting the abdominal cavity acts as 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 may also organ contents, such as gastrointestinal contents, enters the abdominal cavity and additionally causes 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 itself, 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 gastric or duodenal ulcers that break through the organ wall cause bleeding. In addition, there may be a massive hemorrhage in the abdominal cavity when a congenital or acquired Ausackung the wall of the large abdominal aorta (ruptured aortic aneurysm) ruptures.

Sudden onset of circulatory disorders

Sometimes even abnormal blood vessels 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-rays of the abdominal and thoracic space

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 he has discontinued his activity due to severe disturbances in the abdomen. Just as important is the control of heart rate, blood pressure, respiration and body temperature to get an overall picture of the condition of the patient.

Examination of the rectum (rectal palpation)

The palpation of the rectum with the finger completes the medical examination. The doctor feels bottlenecks or tumors (tumors). Bleeding in the lower digestive tract, he sees blood on his gloved finger. The lack of bowel movement on the finger can be an important indicator of passage disorders (suspicious for bowel obstruction).

By taking the medical history and the physical examination of 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, 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. Among other things, the doctor uses this examination method to search 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 (eg splitting of the spleen).


In addition to the ultrasound examination, the doctor also radiographs the lungs and abdomen (thorax and abdomen) in some cases. On the basis of the X-ray images he recognizes, for example, foreign bodies, feces or even free air, which are indications 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 potential complications at an early stage. Not infrequently, the doctor also finds causes of the acute abdomen that he had not previously thought of with this method and can thus expand his therapy decisions. CT is therefore increasingly used in acute abdominal diagnosis.


Sometimes, the doctor also causes a laparoscopy to get a clear diagnosis. In this procedure, also known as keyhole surgery, the patient is given a general anesthetic. 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 area 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 special attention to the organs, which he knows are often the cause of an acute abdomen, for example, the appendix (appendicitis).

What therapeutic measures help with acute abdomen?

The aim of the treatment is to stabilize the vital functions of the organism (for example, breathing and heart function) and to eliminate the cause of the discomfort. Depending on the findings, the doctor decides on a suitable therapy, for example also for an operation. This may also lead to a temporary impairment of the quality of life – for example because of an artificial intestinal output.

If the doctor does not come to a confirmed diagnosis using the usual procedures and the condition of the patient deteriorates, he or she will opt for 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 surgery of the abdomen 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), in which 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 pus ( abscesses ) that may have formed , sutures 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. 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. Which specialist can help depends on the symptoms:

  • Ureteral stones: treatment by urologists
  • Ovarian infections: 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 is no effective preventive measure against appendicitis. 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 a balanced diet and adequate exercise.