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Copyright (c) 2025 Elham Ahmad Mohammed Bokar, Abfulaziz Fahad Alamrani, Mariam Saud Alanazi, Hanan Saud Alanazi, Shahad Abdullah Alanazi, Jamela Ali Mohammed Bahkli, Naif Mohammed Almutairi, Rawia Hassan Maghfouri, Sulaiman Mohammed Ali Albalawi, Naif Ahmed Ghadyan Aljohani

This work is licensed under a Creative Commons Attribution 4.0 International License.
Comprehensive Nursing Assessment and Clinical Management of Patients Presenting with Acute Abdomen-An Updated Review
Corresponding Author(s) : Elham Ahmad Mohammed Bokar
Saudi Journal of Medicine and Public Health, Vol. 2 No. 2 (2025)
Abstract
Background: Acute abdomen is a common emergency presentation requiring rapid diagnosis due to potentially life-threatening causes such as infection, obstruction, ischemia, and perforation.
Aim: This review aims to summarize updated clinical assessment and management approaches.
Methodology: Methods include structured evaluation of patient history, physical examination, and targeted laboratory and imaging studies.
Results: Results highlight the diverse gastrointestinal, vascular, urologic, and gynecologic etiologies contributing to diagnostic complexity. Effective management requires early stabilization, analgesia, antibiotics when indicated, and timely surgical referral.
Conclusion: A systematic, evidence-based approach improves outcomes.
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- Elhardello OA, MacFie J. Digital rectal examination in patients with acute abdominal pain. Emerg Med J. 2018 Sep;35(9):579-580.
- Maleki Verki M, Motamed H. Rectus Muscle Hematoma as a Rare Differential Diagnosis of Acute Abdomen; a Case Report. Emerg (Tehran). 2018;6(1):e28.
- Kaushal-Deep SM, Anees A, Khan S, Khan MA, Lodhi M. Primary cecal pathologies presenting as acute abdomen and critical appraisal of their current management strategies in emergency settings with review of literature. Int J Crit Illn Inj Sci. 2018 Apr-Jun;8(2):90-99.
- Buel KL, Wilcox J, Mingo PT. Acute Abdominal Pain in Children: Evaluation and Management. Am Fam Physician. 2024 Dec;110(6):621-631.
- Jamsheer F, Alsudairy N. Pulmonary Embolism Masquerading as Acute Abdominal Pain: A Rare and Challenging Diagnosis. Cureus. 2024 Nov;16(11):e74623.
- Tsukamoto T, Kunimoto T, Kaizaki R. Gallbladder perforation causing local peritonitis in left upper abdomen: A case report. Int J Surg Case Rep. 2025 Jan;126:110772.
- Wolfe JM, Lein DY, Lenkoski K, Smithline HA. Analgesic administration to patients with an acute abdomen: a survey of emergency medicine physicians. Am J Emerg Med. 2000 May;18(3):250-3.
- Haider SM, Ashraf MN, Niaz K, Abbas MH, Rehman U. A Case Report of Drug-Induced Acute Gastric Necrosis. Cureus. 2024 Nov;16(11):e73696.
- Marin Cuartas T, Nasri AF, Bollmann S. [Atypical spontaneous bacterial peritonitis linked to streptococcal toxic shock syndrome]. Dtsch Med Wochenschr. 2025 Jan;150(1-02):44-47.
- Shahi R, Siddiqui NH, Khan IA, Bashar MA. Etiologies and Outcomes Following Duodenal Perforation in Acute Peritonitis: A Systematic Review. Cureus. 2024 Nov;16(11):e74707.
- González García J, Cruz Hernandez BD, Pérez Solis LF, Pucheta Hernández NA, Trujillo Rodríguez JE, Martinez Bravo VM. Acute Gastric Necrosis Secondary to Mesenteric Ischemia: A Case Report and Literature Review. Cureus. 2024 Dec;16(12):e76680.
- Binko MA, Andraska EA, Reitz KM, Handzel RM, Singh MJ, Sridharan ND, Chaer RA, Hager ES. The natural history of portal venous system aneurysms. J Vasc Surg Venous Lymphat Disord. 2025 May;13(3):102163.
- Sultana R, Noor S, Fawwad A, Abbasi N, Bashir R. Septic/unsafe abortion: a preventable tragedy. J Ayub Med Coll Abbottabad. 2012 Jul-Dec;24(3-4):154-6.
- Li PH, Tee YS, Fu CY, Liao CH, Wang SY, Hsu YP, Yeh CN, Wu EH. The Role of Noncontrast CT in the Evaluation of Surgical Abdomen Patients. Am Surg. 2018 Jun 01;84(6):1015-1021.
- Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F, Lippi G. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med. 2016 Oct;4(19):362.
- de Burlet K, Lam A, Larsen P, Dennett E. Acute abdominal pain-changes in the way we assess it over a decade. N Z Med J. 2017 Oct 06;130(1463):39-44.
- Sabir F, Hanif S, Gardezi F, Saeed M, Bibi R, Haider S. ADMISSION WITH ACUTE ABDOMEN: PRESENTATION, CONDITIONS IDENTIFIED AND MANAGEMENT OUTCOMES. J Ayub Med Coll Abbottabad. 2024 Jan-Mar;36(1):165-169.
- Tseng YC, Lee MS, Chang YJ, Wu HP. Acute abdomen in pediatric patients admitted to the pediatric emergency department. Pediatr Neonatol. 2008 Aug;49(4):126-34.
- Govender I, Rangiah S, Bongongo T, Mahuma P. A Primary Care Approach to Abdominal Pain in Adults. S Afr Fam Pract (2004). 2021 Mar 10;63(1):e1-e5.
- Mahmood A, Abdul Rahman S, Chua SM, Abdelgawwad W. Small Bowel Obstruction as a Complication of Acute Pancreatitis. Cureus. 2024 Nov;16(11):e74800.
- Gu Y, Lim HJ, Moser MA. How useful are bowel sounds in assessing the abdomen? Dig Surg. 2010;27(5):422-6.
- Eskelinen M, Ikonen J, Lipponen P. Contributions of history-taking, physical examination, and computer assistance to diagnosis of acute small-bowel obstruction. A prospective study of 1333 patients with acute abdominal pain. Scand J Gastroenterol. 1994 Aug;29(8):715-21.
- Leidi A, Saudan A, Soret G, Rouyer F, Marti C, Stirnemann J, Reny JL, Grosgurin O. Confidence and use of physical examination and point-of-care ultrasonography for detection of abdominal or pleural free fluid. A cross-sectional survey. Intern Emerg Med. 2022 Jan;17(1):113-122.
- Feuerstein JD, Falchuk KR. Diverticulosis and Diverticulitis. Mayo Clin Proc. 2016 Aug;91(8):1094-104.
- Nienaber CA, Fattori R, Mehta RH, Richartz BM, Evangelista A, Petzsch M, Cooper JV, Januzzi JL, Ince H, Sechtem U, Bossone E, Fang J, Smith DE, Isselbacher EM, Pape LA, Eagle KA., International Registry of Acute Aortic Dissection. Gender-related differences in acute aortic dissection. Circulation. 2004 Jun 22;109(24):3014-21.
- Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, Myrmel T, Larsen M, Harris KM, Greason K, Di Eusanio M, Bossone E, Montgomery DG, Eagle KA, Nienaber CA, Isselbacher EM, O'Gara P. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015 Jul 28;66(4):350-8.
- Yang XF, Liu JL. Acute incarcerated external abdominal hernia. Ann Transl Med. 2014 Nov;2(11):110.
- Lee SY, Bhaduri M. Cecal volvulus. CMAJ. 2013 May 14;185(8):684.
- Sathiyamoorthi N, Maduranga LSKKP, Thomas S, Vyas V. Porcelain appendix: a rare mimicker of the acute abdomen. BMJ Case Rep. 2024 Dec 18;17(12)
- Pearson J, Greminger A, Onello E, Stover S. Teaching the Evaluation of Female Pelvic Pain: A Hands-On Simulation to Reinforce Exam Skills and Introduce Transvaginal Ultrasound. MedEdPORTAL. 2021 Jan 25;17:11080.
- Segura Grau A, Mejías Gil M, Román Garrido M. [Use of clinical ultrasound in primary care: Acute abdominal pain]. Semergen. 2024 Dec;50(9):102369.
- Lee CH, Leu HS, Hu TH, Liu JW. Splenic abscess in southern Taiwan. J Microbiol Immunol Infect. 2004 Feb;37(1):39-44.
- Brewer J, Conger H, Rash R. The erector spinae block: a novel approach to pain management in acute appendicitis. Ultrasound J. 2022 Jul 26;14(1):30.
- Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012;5:789-97.
- Kumar D, Garg I, Sarwar AH, Kumar L, Kumar V, Ramrakhia S, Naz S, Jamil A, Iqbal ZQ, Kumar B. Causes of Acute Peritonitis and Its Complication. Cureus. 2021 May 28;13(5):e15301.
References
Elhardello OA, MacFie J. Digital rectal examination in patients with acute abdominal pain. Emerg Med J. 2018 Sep;35(9):579-580.
Maleki Verki M, Motamed H. Rectus Muscle Hematoma as a Rare Differential Diagnosis of Acute Abdomen; a Case Report. Emerg (Tehran). 2018;6(1):e28.
Kaushal-Deep SM, Anees A, Khan S, Khan MA, Lodhi M. Primary cecal pathologies presenting as acute abdomen and critical appraisal of their current management strategies in emergency settings with review of literature. Int J Crit Illn Inj Sci. 2018 Apr-Jun;8(2):90-99.
Buel KL, Wilcox J, Mingo PT. Acute Abdominal Pain in Children: Evaluation and Management. Am Fam Physician. 2024 Dec;110(6):621-631.
Jamsheer F, Alsudairy N. Pulmonary Embolism Masquerading as Acute Abdominal Pain: A Rare and Challenging Diagnosis. Cureus. 2024 Nov;16(11):e74623.
Tsukamoto T, Kunimoto T, Kaizaki R. Gallbladder perforation causing local peritonitis in left upper abdomen: A case report. Int J Surg Case Rep. 2025 Jan;126:110772.
Wolfe JM, Lein DY, Lenkoski K, Smithline HA. Analgesic administration to patients with an acute abdomen: a survey of emergency medicine physicians. Am J Emerg Med. 2000 May;18(3):250-3.
Haider SM, Ashraf MN, Niaz K, Abbas MH, Rehman U. A Case Report of Drug-Induced Acute Gastric Necrosis. Cureus. 2024 Nov;16(11):e73696.
Marin Cuartas T, Nasri AF, Bollmann S. [Atypical spontaneous bacterial peritonitis linked to streptococcal toxic shock syndrome]. Dtsch Med Wochenschr. 2025 Jan;150(1-02):44-47.
Shahi R, Siddiqui NH, Khan IA, Bashar MA. Etiologies and Outcomes Following Duodenal Perforation in Acute Peritonitis: A Systematic Review. Cureus. 2024 Nov;16(11):e74707.
González García J, Cruz Hernandez BD, Pérez Solis LF, Pucheta Hernández NA, Trujillo Rodríguez JE, Martinez Bravo VM. Acute Gastric Necrosis Secondary to Mesenteric Ischemia: A Case Report and Literature Review. Cureus. 2024 Dec;16(12):e76680.
Binko MA, Andraska EA, Reitz KM, Handzel RM, Singh MJ, Sridharan ND, Chaer RA, Hager ES. The natural history of portal venous system aneurysms. J Vasc Surg Venous Lymphat Disord. 2025 May;13(3):102163.
Sultana R, Noor S, Fawwad A, Abbasi N, Bashir R. Septic/unsafe abortion: a preventable tragedy. J Ayub Med Coll Abbottabad. 2012 Jul-Dec;24(3-4):154-6.
Li PH, Tee YS, Fu CY, Liao CH, Wang SY, Hsu YP, Yeh CN, Wu EH. The Role of Noncontrast CT in the Evaluation of Surgical Abdomen Patients. Am Surg. 2018 Jun 01;84(6):1015-1021.
Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F, Lippi G. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med. 2016 Oct;4(19):362.
de Burlet K, Lam A, Larsen P, Dennett E. Acute abdominal pain-changes in the way we assess it over a decade. N Z Med J. 2017 Oct 06;130(1463):39-44.
Sabir F, Hanif S, Gardezi F, Saeed M, Bibi R, Haider S. ADMISSION WITH ACUTE ABDOMEN: PRESENTATION, CONDITIONS IDENTIFIED AND MANAGEMENT OUTCOMES. J Ayub Med Coll Abbottabad. 2024 Jan-Mar;36(1):165-169.
Tseng YC, Lee MS, Chang YJ, Wu HP. Acute abdomen in pediatric patients admitted to the pediatric emergency department. Pediatr Neonatol. 2008 Aug;49(4):126-34.
Govender I, Rangiah S, Bongongo T, Mahuma P. A Primary Care Approach to Abdominal Pain in Adults. S Afr Fam Pract (2004). 2021 Mar 10;63(1):e1-e5.
Mahmood A, Abdul Rahman S, Chua SM, Abdelgawwad W. Small Bowel Obstruction as a Complication of Acute Pancreatitis. Cureus. 2024 Nov;16(11):e74800.
Gu Y, Lim HJ, Moser MA. How useful are bowel sounds in assessing the abdomen? Dig Surg. 2010;27(5):422-6.
Eskelinen M, Ikonen J, Lipponen P. Contributions of history-taking, physical examination, and computer assistance to diagnosis of acute small-bowel obstruction. A prospective study of 1333 patients with acute abdominal pain. Scand J Gastroenterol. 1994 Aug;29(8):715-21.
Leidi A, Saudan A, Soret G, Rouyer F, Marti C, Stirnemann J, Reny JL, Grosgurin O. Confidence and use of physical examination and point-of-care ultrasonography for detection of abdominal or pleural free fluid. A cross-sectional survey. Intern Emerg Med. 2022 Jan;17(1):113-122.
Feuerstein JD, Falchuk KR. Diverticulosis and Diverticulitis. Mayo Clin Proc. 2016 Aug;91(8):1094-104.
Nienaber CA, Fattori R, Mehta RH, Richartz BM, Evangelista A, Petzsch M, Cooper JV, Januzzi JL, Ince H, Sechtem U, Bossone E, Fang J, Smith DE, Isselbacher EM, Pape LA, Eagle KA., International Registry of Acute Aortic Dissection. Gender-related differences in acute aortic dissection. Circulation. 2004 Jun 22;109(24):3014-21.
Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, Myrmel T, Larsen M, Harris KM, Greason K, Di Eusanio M, Bossone E, Montgomery DG, Eagle KA, Nienaber CA, Isselbacher EM, O'Gara P. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015 Jul 28;66(4):350-8.
Yang XF, Liu JL. Acute incarcerated external abdominal hernia. Ann Transl Med. 2014 Nov;2(11):110.
Lee SY, Bhaduri M. Cecal volvulus. CMAJ. 2013 May 14;185(8):684.
Sathiyamoorthi N, Maduranga LSKKP, Thomas S, Vyas V. Porcelain appendix: a rare mimicker of the acute abdomen. BMJ Case Rep. 2024 Dec 18;17(12)
Pearson J, Greminger A, Onello E, Stover S. Teaching the Evaluation of Female Pelvic Pain: A Hands-On Simulation to Reinforce Exam Skills and Introduce Transvaginal Ultrasound. MedEdPORTAL. 2021 Jan 25;17:11080.
Segura Grau A, Mejías Gil M, Román Garrido M. [Use of clinical ultrasound in primary care: Acute abdominal pain]. Semergen. 2024 Dec;50(9):102369.
Lee CH, Leu HS, Hu TH, Liu JW. Splenic abscess in southern Taiwan. J Microbiol Immunol Infect. 2004 Feb;37(1):39-44.
Brewer J, Conger H, Rash R. The erector spinae block: a novel approach to pain management in acute appendicitis. Ultrasound J. 2022 Jul 26;14(1):30.
Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012;5:789-97.
Kumar D, Garg I, Sarwar AH, Kumar L, Kumar V, Ramrakhia S, Naz S, Jamil A, Iqbal ZQ, Kumar B. Causes of Acute Peritonitis and Its Complication. Cureus. 2021 May 28;13(5):e15301.