Acute abdominal pain (acute abdomen)

Acute abdominal pain (acute abdomen)

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Severe and sudden abdominal pain

Acute and severe abdominal pain as an emergency: The term acute abdomen or acute abdomen collects various abdominal diseases in which a life-threatening condition can suddenly occur. The acute abdomen is accompanied by severe abdominal pain that appears colicky or permanent. The severe pain is often accompanied by nausea and vomiting. A palpable abdominal wall (due to muscular defensive tension) and a bloated abdomen often occur in the absence of bowel movements or outgoing winds. An emergency is urgent if the persistent abdominal pain is accompanied by vomiting blood, fever, tachycardia (rapid heartbeat), drop in blood pressure, paleness of the face or cold sweat. Then there is a risk of shock and circulatory failure, which urgently need intensive care treatment.

Acute belly: a brief overview

If there is sudden and violent pain in the abdomen, which becomes relapsing or progressively stronger, this is often a sign of a medical emergency. Serious and life-threatening illnesses can be responsible for these complaints, especially if the pain is accompanied by other symptoms. If in doubt, do not wait, but call an emergency doctor immediately. Here is a brief overview of the symptoms:

  • Synonyms: Acute abdomen, surgical abdomen, surgical abdomen, acute abdomen, acute abdominal pain, acute abdomen, severe abdominal pain.
  • Symptoms: sudden and intense abdominal pain, nausea, vomiting, hard abdominal wall, bloated stomach.
  • Emergency: If the condition worsens continuously and symptoms such as vomiting of the blood, rapid heartbeat, drop in blood pressure, pallor, dizziness, cold sweat, shock and breathing difficulties occur, an emergency doctor should be called immediately.
  • Possible causes: gastrointestinal infection and some other infectious diseases, intestinal obstruction, peritonitis, ulcer disease, biliary colic, inflammation of the gallbladder, biliary perforation, inflammation of the pancreas, inflammation of the small intestine, colon or appendix, internal injuries, ruptured abdominal artery, closure of an abdominal artery, heart attack.

What to do in an emergency?

Sudden acute abdominal discomfort is often a sign of an emergency. As the German Red Cross reports, helpers and those affected should behave as follows if such an emergency occurs:

  • Alert the emergency services on number 112.
  • Those affected should be reassured and looked after until the ambulance arrives.
  • Unrest and hectic pace should be avoided.
  • Affected should be covered warm.
  • Sick people often adopt a gentle posture with their knees drawn up. This posture can be supported by pillows or a knee roll between the legs.
  • If breathing difficulties occur, the upper body should be stored elevated.
  • Affected people should not eat or drink under any circumstances, as an impending emergency operation is likely.
  • Likewise, no medication should be given. This can make diagnosis more difficult.

Causes of acute abdominal pain

A variety of diseases are possible, on the bottom of which an acute abdomen can develop. The professional association of German internists lists the following diseases as a common cause of an acute abdomen:

  • Inflammation of the gallbladder,
  • Appendicitis,
  • Inflammation of intestinal wall protrusions (diverticulitis),
  • massive disorder up to the closure of the intestinal passage (ileus),
  • acute pancreatitis (pancreatitis),
  • Breakthrough gastric or duodenal ulcer,
  • acute occlusion of an intestinal vessel (mesenteric infarction),
  • pinched ureteral stones or gallstones,
  • pinched hernia,
  • Colon cancer,
  • Adhesions in connective tissue,
  • Protrusion of a blood vessel (aortic aneurysm) with bleeding into the vessel wall,
  • special forms of heart attack (posterior wall infarction),
  • Lung infection,
  • Inflammation of the pleura,
  • gynecological diseases,
  • Testicular torsion,
  • derailed diabetes,
  • Kidney failure (uremia),
  • internal injuries in the abdomen.

Digestive system diseases

From the area of ​​the digestive organs, intestinal obstruction (ileus) and peritonitis (inflammation of the peritoneum) as well as ulcer disease with bleeding or breakthrough of the ulcers should be mentioned. Furthermore, the cause is biliary colic, acute gallbladder infection and perforation (breakthrough of the gallbladder), but also acute pancreatitis, all of which are usually accompanied by (sometimes cramp-like) pain in the right upper abdomen. Intestinal inflammation such as ileitis and colitis, as well as acute appendicitis (appendicitis) often show up with pain in the umbilical region, while acute diverticulitis of the colon typically causes pain in the left lower abdomen.

Liver or spleen as the cause

Acute liver disease can cause sudden and violent abdominal pain. The causes for this are, for example, congestion, inflammation, abscesses or a rupture of the liver. Acute splenic disease can also be the cause of an acute abdomen. A spleen infarction, abscess, or splenic tear can trigger the above symptoms. A splenic tear can lead to life-threatening internal bleeding. In rare cases, splenic rupture can also occur as a complication of Pfeifferer's glandular fever.

Infectious diseases

Complicated courses of infectious diseases can also lead to acute abdomen, such as malaria, TBC, typhoid or viral hepatitis. The abdominal pain can be felt diffusely in the umbilical region and is described as dull, boring or cramping.


Impact, impact or impact injuries in the abdominal region can injure organs and lead to a splenic tear or liver tear. Pain is in accordance with the position of the organ in splenic rupture in the left, in liver rupture especially. noticeable in the right upper abdomen.

Blood vessels

A burst aortic aneurysm of the abdominal artery leads to severe abdominal pain, which is often accompanied by shoulder pain and back pain. Just like a mesenteric infarction, which can occur suddenly due to the closure of an abdominal artery and in which symptom-free intervals alternate with diffuse abdominal pain after severe pain.

Causes outside the abdomen

A heart attack can occur if the abdominal pain does not appear below the umbilical region. Pericarditis or lung diseases such as pneumonia and pneumonia are often accompanied by fever and breathing-related pain.

Diabetes as the cause

Derailed sugar levels in diabetes mellitus can lead to an absolute insulin deficiency. This condition is medically known as ketoacidosis. Acute abdominal pain and other non-specific symptoms such as difficulty breathing, nausea and vomiting, frequent urination, thirst and weakness can also occur. Ketoacidosis must be treated promptly, otherwise the condition will be fatal.

Metabolic disorders

A severe lipid metabolism disorder can lead to an extreme increase in blood triglyceride levels. This can lead to inflammation of the pancreas, which in turn is manifested by severe acute abdominal pain. In addition, a massive hyperthyroidism can trigger a so-called thyroid toxicity crisis, which is manifested, among other things, by a sudden pain in the abdomen. This metabolic derailment is a life-threatening condition that needs immediate medical attention. The hypercalcaemic crisis, in which increased calcium in the blood is the trigger, is just as threatening. The cause of the high calcium content is often cancer diseases such as bone tumors, multiple myeloma or a tumor on the parathyroid gland.

Gynecological causes

Pain in the right or left lower abdomen, on the other hand, indicates organs in the small pelvis. Inflammation of the fallopian tubes, inflammation of the ovaries, pregnancy of the fallopian tubes or abdominal cavity (ectopic pregnancy) and pedicle-turned ovarian cysts are possible in women, epididymitis or testicular torsion in men. A jammed hernia (incarcerated hernia) should also be considered. (jvs, vb; updated on April 29, 2019)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Graduate Editor (FH) Volker Blasek, Dr. med. Andreas Schilling


  • Professional Association of German Internists e. V .: Abdominal pain in an emergency, (access 01.07.2019), internists on the net
  • German Red Cross: Acute diseases of the abdominal organs, (accessed 01.07.2019), DRK
  • Working Group of the Scientific Medical Societies (AWMF) e.V .: Abdominal Pain in Children, (Call 01.07.2019), AWMF
  • Hubert Hauser (ed.), Heinz J. Buhr (ed.), Hans-Jörg Mischinger (ed.): Acute Abdomen, Springer Verlag, 1st edition, 2016
  • Parswa Ansari: Acute Abdominal Pain, MSD Manual, (accessed 01.07.2019), MSD

ICD codes for this disease: R10.0ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

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