Current Topics in Acute Abdomen: Causes, Diagnostics, and Emerging Therapies ()
1. Introduction
Acute abdomen is a clinical condition characterized by sudden and intense abdominal pain, often accompanied by other symptoms such as nausea, vomiting, and abdominal distension.
Among the possible etiologies leading to this condition, perforative acute abdomen stands out as one of the causes prompting patients to seek medical assistance [1] .
The evaluation of patients with acute abdomen relies on computed tomography as the method of choice, being essential for accurate diagnosis and definition of appropriate treatment [2] .
Acute abdomen can have various causes, from acute appendicitis to intestinal perforations, and it is essential to consider the possibility of foreign bodies in the gastrointestinal tract as a cause, especially in unusual cases, such as colonic perforation by a foreign object, as reported in a case of a tetraplegic man who died of purulent peritonitis due to colonic perforation by a transanally introduced zucchini [3] [4] .
Additionally, the presence of acute abdomen in patients with non-traumatic diseases may require damage control strategies to improve outcomes, with in-hospital mortality rates around 12% [5] .
The therapeutic approach to acute abdomen may vary, with appendectomy being one of the most common surgical interventions in these cases.
Comparative studies between laparoscopic and open appendectomy have demonstrated that the laparoscopic approach is safe, effective, and associated with significant clinical benefits, such as shorter hospital stay, reduced need for postoperative analgesia, and earlier return to normal activities, despite slightly higher hospital costs [6] .
The objective of this paper is to conduct a narrative review of the literature on the most common types of acute abdomen.
2. Methodology
The theme of the narrative review will be acute abdomen and its most frequent types, with the scope limited to studies published within specific periods, without a year limit. Data were selected from the PubMed and Scielo databases using relevant keywords.
For the PubMed search, the following descriptors were used in conjunction with Boolean operators:
(“Abdominal pain” OR “Acute abdomen”) AND (Prevalence OR Incidence) AND (Appendicitis OR “Perforated peptic ulcer” OR “Acute pancreatitis” OR “Ruptured sigmoid diverticulum” OR “Ovarian torsion” OR Volvulus OR “Aortic aneurysm” OR “Lacerated spleen or liver” OR “Intestinal ischemia”) AND (Clinical trial OR Randomized controlled trial)
And for the Scielo search, the following descriptors were used in conjunction with Boolean operators:
(“Abdominal pain” OR “Acute abdomen”) AND (Prevalence OR Incidence) AND (Appendicitis OR “Perforated peptic ulcer” OR “Acute pancreatitis” OR “Ruptured sigmoid diverticulum” OR “Ovarian torsion” OR Volvulus OR “Aortic aneurysm” OR “Lacerated spleen or liver” OR “Intestinal ischemia”) AND (Clinical trial OR Randomized controlled trial)
The review will include original studies, such as clinical trials, observational studies, among others, if they are related to the theme. Studies unrelated to acute abdomen, articles in languages other than Portuguese or English will be excluded. Independent readings of the selected studies were conducted, and relevant data such as objectives, methodology, results, and conclusions were extracted.
3. Results
The narrative review on the management and treatment of acute abdomen revealed a wide range of underlying causes, challenging diagnoses, and emerging therapies, as can be seen in Table 1. Upon examination of the primary sources, it was found that acute abdomen can be triggered by a variety of etiologies, including acute appendicitis, cholecystitis, pancreatitis, intestinal obstruction, among others.
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Table 1. Titles and objectives of the articles, authorial source 2024.
Diagnostic strategies, while fundamental, often prove complex due to symptom overlap among different conditions. The review highlighted the importance of careful clinical assessment, along with the use of complementary tests such as laboratory examinations, ultrasound, computed tomography, and, in some cases, magnetic resonance imaging, to guide diagnosis with greater precision.
Regarding therapies, several approaches were identified, ranging from conservative treatment with clinical observation and antibiotic therapy to urgent surgical interventions such as appendectomy and cholecystectomy. Additionally, promising evidence has emerged regarding the use of minimally invasive approaches, such as laparoscopy, in the effective management of acute abdomen, especially in selected cases of challenging diagnosis.
The conclusions drawn from the findings in Table 2 underscore critical insights into the diagnostic landscape of acute abdominal conditions across various contexts. In the year 2022, it was elucidated that the diagnostic evaluation of acute abdomen commences with a meticulous clinical assessment, comprehensive medical history, and thorough physical examination.
Moreover, the complexities surrounding the diagnosis of acute abdominal pain in pediatric patients were highlighted, emphasizing the necessity of a systematic approach and in-depth understanding of primary etiological factors to facilitate appropriate therapeutic interventions.
In 2021, the exigency of specialized attention towards acute abdomen during pregnancy was underscored, acknowledging the inherent risks posed to both the maternal and fetal entities. Precision in diagnosis and timely interventions emerged as pivotal determinants in ensuring favorable prognostic outcomes.
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Table 2. Conclusions and publication year, authorial source 2024.
Furthermore, the grave clinical implications of obstructive acute abdomen were underscored in 2020, stressing the imperative of immediate medical intervention. The significance of precise diagnosis in delineating the underlying cause of obstruction and subsequently instituting tailored treatment regimens was underscored as paramount.
In a retrospective reflection back to 2003, laparoscopy emerged as a beacon of hope, exhibiting commendable diagnostic accuracy. Its employment facilitated satisfactory therapeutic management, concomitantly minimizing morbidity rates, and expediting postoperative recoveries.
These cumulative insights underscore a nuanced understanding of the diagnostic paradigms surrounding acute abdominal pathologies, urging for continued research endeavors to refine diagnostic methodologies and therapeutic interventions in pursuit of enhanced patient outcomes.
4. Discussion
Acute abdomen is a serious clinical condition that requires immediate attention due to its association with intense pain and rapid evolution. Recent studies highlight that acute appendicitis is one of the most common causes of acute abdomen, leading many patients to surgical emergency rooms [7] [8] .
Furthermore, obstructive acute abdomen, such as in the case of cecal volvulus, is a lethal presentation of this condition. Computed tomography plays a crucial role in diagnosing acute abdomen, allowing for precise and rapid evaluation, especially in cases of intestinal obstruction [9] .
However, the COVID-19 pandemic has impacted the diagnosis and treatment of acute abdomen cases, resulting in delays and difficulties in accessing necessary healthcare services [2] . This has led to increased morbidity and mortality from these conditions due to healthcare system overload [2] [10] [11] [12] .
Other less common causes of acute abdomen include conditions such as biliary ileus, internal hernia, and leiomyomatous degeneration, which can lead to serious complications such as perforation and intestinal obstruction [2] [11] [12] .
The diversity of clinical presentations of acute abdomen, along with the need for rapid and accurate intervention, underscores the importance of careful differential diagnosis and knowledge of best practices for managing this condition [13] [14] .
5. Conclusions
The assessment and management of acute abdomen represent a significant challenge for healthcare professionals, given the diversity of underlying causes, the complexity of diagnoses, and the therapeutic urgency required by this clinical condition. In this integrative review, we were able to examine various etiologies of acute abdomen, ranging from the most common, such as acute appendicitis, to the less frequent, such as intestinal perforations by foreign bodies.
The results underscored the importance of careful clinical evaluation, combined with the use of imaging methods such as computed tomography, in the diagnostic process. Additionally, we observed that laparoscopy emerges as a promising therapeutic approach, offering advantages in terms of recovery and postoperative morbidity.
However, the COVID-19 pandemic has brought additional challenges to the diagnosis and treatment of acute abdomen, highlighting the need for adaptation and swift response by healthcare systems.
In summary, this review reinforces the importance of a multidisciplinary approach and continuous professional development in addressing acute abdomen. The pursuit of accurate diagnoses and appropriate therapeutic interventions remains crucial for improving clinical outcomes and reducing the morbidity and mortality associated with this complex clinical condition.