Acute abdominal pain

Acute abdominal pain is a common acute presentation in clinical practice. It encompasses a very broad range of possible etiologies and diagnoses, and imaging is routinely employed as the primary investigative tool in its modern management.


A subgroup of patients with acute abdominal pain will have a so-called acute abdomen (also known as an acute surgical abdomen). This is restricted to those with an acute presentation of abdominal pain coupled with serious morbidity, a tender abdomen and marked rigidity (a.k.a. involuntary guarding) on abdominal physical examination.


It is estimated that approximately 5% presentations to a typical emergency department are for acute abdominal pain .

Clinical presentation

Acute abdominal pain includes a wide spectrum of severity and differing character, with qualifying descriptors, such as sharp, colicky, dull, etc.



The list of causes of acute abdominal pain is extremely long, and can be subdivided in a multiplicity of ways.

Common causes
Less common causes
  • penetrating abdominal injury
  • blunt abdominal injury
Medical causes

Many medical conditions can present with an acute abdominal pain. In some cases it may be an atypical presentation of a common condition (e.g. myocardial ischemia), or a typical presentation of a rare condition (e.g. porphyria). This list is not exhaustive.

Functional GI disorders

Radiographic features

CT of the abdomen and pelvis is the first-line investigation for many presentations of acute abdominal pain. Traditionally, the plain abdominal radiograph was the initial investigation but has fallen out of favor due to its poor sensitivity and specificity for many of the causes of abdominal pain.

Plain radiograph

Historically the plain abdominal radiograph was mandatory in every patient presenting with an acute abdomen.


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Treatment and prognosis

In the pre-CT era, patients with an acute abdomen were often sent for urgent surgery. Contemporaneously, with the virtually ubiquitous availability of CT, some of these patients will not be operated on at all. Conversely, some patients who do not meet the traditional criteria for an "acute abdomen" will be diagnosed on imaging with conditions, such as acute appendicitis, and be sent for surgery.

Practical approach

A pragmatic approach needs to be taken by clinicians/radiologists when considering the potential causes of an acute abdomen and a surgical sieve may be helpful as a starting point.

Beware of a normal abdominal radiograph providing a false sense of security. Emergent pathologies including bowel obstruction and perforation may not produce a radiographic abnormality.