Acute abdominal pain: causes, diagnosis and when to see a surgeon
Acute abdominal pain is one of the most common reasons for visiting the emergency department. Sometimes the cause is mild, but other times it may indicate a serious condition that requires urgent treatment. A careful evaluation is essential to identify the underlying problem and decide on the most appropriate management.
Surgical causes of acute abdominal pain
Some conditions require urgent surgery because they can worsen rapidly. The most frequent include:
Acute appendicitis
Inflammation of the appendix, which may progress to perforation if not treated in time. Pain often begins in the centre of the abdomen and later moves to the right lower quadrant.
Acute cholecystitis
Inflammation of the gallbladder, usually due to gallstones. It causes pain in the upper right abdomen, fever and general discomfort. Without treatment, it may lead to infection or perforation.
Diverticulitis
Inflammation or infection of diverticula in the colon. It typically causes pain in the lower left abdomen and may be accompanied by fever and changes in bowel habits. Complications include abscesses, bleeding or perforation.
Intestinal obstruction
A blockage in the bowel caused by adhesions, hernias or tumours. It produces colicky pain, vomiting and abdominal distension. Prompt diagnosis is essential to prevent intestinal necrosis.
Peritonitis
Inflammation of the abdominal cavity lining, usually caused by perforation of an abdominal organ (ulcer, diverticulum, appendix…). It presents with severe pain, rigid abdomen and rapid deterioration. It is a surgical emergency.
Severe mesenteric ischaemia
Reduced blood flow to the intestines. It often presents with pain that is disproportionate to physical findings. If not diagnosed early, it can lead to intestinal necrosis.
These conditions typically require urgent surgery, as delaying treatment increases the risk of severe complications.
Non-surgical causes of acute abdominal pain
Not all intense abdominal pain requires an operation. Common medical causes include:
Gastroenteritis
Infection of the gastrointestinal tract causing abdominal pain, diarrhoea, vomiting and general discomfort.
Renal colic
Sudden, intense pain due to a stone moving through the ureter. It may radiate to the groin and be accompanied by blood in the urine.
Mild acute pancreatitis
Inflammation of the pancreas related to alcohol use or gallstones. It produces upper abdominal pain radiating to the back, nausea and vomiting.
Inflammatory bowel disease (IBD)
Flare-ups of Crohn’s disease or ulcerative colitis can cause acute pain, diarrhoea, mucus or bleeding.
Peptic ulcer disease
An ulcer may bleed or perforate, triggering sharp abdominal pain. Complicated ulcers may require hospital treatment.
Key diagnostic tests
Diagnosis always begins with a thorough medical history and physical examination —including abdominal and extra-abdominal assessment.
To confirm the suspected diagnosis, additional tests are usually performed:
Blood tests
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Full blood count to detect infection or inflammation (leucocytosis).
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Liver and kidney function tests.
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Amylase and lipase levels to rule out pancreatitis.
Urine analysis
Useful for detecting urinary infections or blood in the urine in renal colic.
Imaging tests
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Abdominal ultrasound: valuable for evaluating the gallbladder, bile ducts and kidneys.
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CT scan: the most accurate test for diagnosing appendicitis, obstruction, perforation and complicated diverticulitis.
These tests help identify the exact cause and determine whether surgical or medical treatment is required.
The surgeon’s role in acute abdominal pain
A surgeon plays a crucial role when a surgical cause is suspected. Sometimes the difference between a favourable outcome and a serious complication is simply acting early.
The surgeon:
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Assesses whether urgent surgery is required
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Decides which diagnostic tests are necessary
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Determines if medical treatment is sufficient or surgery is essential
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Provides postoperative care and follow-up
Not all patients present with classic symptoms, and part of the surgeon’s expertise lies in recognising atypical cases and guiding the best management plan.
If you experience intense or persistent abdominal pain, seek medical evaluation as soon as possible to identify the cause and receive appropriate treatment.