Evaluation of acute abdomen


Key articles

American College of Radiology. ACR Appropriateness Criteria: acute nonlocalized abdominal pain. 2018 [internet publication].Full text  Abstract

American College of Radiology. ACR appropriateness criteria: right lower quadrant pain. 2022 [internet publication].Full text

American College of Radiology. ACR Appropriateness Criteria: left lower quadrant pain-suspected diverticulitis. 2018 [internet publication].Full text  Abstract

American College of Radiology. ACR appropriateness criteria®: right upper quadrant pain. 2022 [internet publication].Full text

Reference articles

1. Hooker EA, Mallow PJ, Oglesby MM. Characteristics and trends of emergency department visits in the United States (2010-2014). J Emerg Med. 2019 Mar;56(3):344-51. Abstract

2. Silen W. Cope's early diagnosis of the acute abdomen. 22nd ed. New York, NY: Oxford University Press; 2010.

3. Association of Surgeons of Great Britain and Ireland. Commissioning guide: emergency general surgery (acute abdominal pain). Apr 2014 [internet publication].Full text

4. Stefanidis D, Richardson WS, Chang L, et al. The role of diagnostic laparoscopy for acute abdominal conditions: an evidence-based review. Surg Endosc. 2009 Jan;23(1):16-23. Abstract

5. Maggio AQ, Reece-Smith AM, Tang TY, et al. Early laparoscopy versus active observation in acute abdominal pain: systematic review and meta-analysis. Int J Surg. 2008 Oct;6(5):400-3.Full text  Abstract

6. Society of American Gastrointestinal and Endoscopic Surgeons. Guidelines for diagnostic laparoscopy. Apr 2010 [internet publication].Full text

7. Manterola C, Vial M, Moraga J, et al. Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD005660.Full text  Abstract

8. Chen EH, Mills AM. Abdominal pain in special populations. Emerg Med Clin North Am. 2011 May;29(2):449-58. Abstract

9. Ragsdale L, Southerland L. Acute abdominal pain in the older adult. Emerg Med Clin North Am. 2011 May;29(2):429-48. Abstract

10. Kilpatrick CC, Monga M. Approach to the acute abdomen in pregnancy. Obstet Gynecol Clin North Am. 2007 Sep;34(3):389-402. Abstract

11. McKean J, Ronan-Bentle S. Abdominal pain in the immunocompromised patient-human immunodeficiency virus, transplant, cancer. Emerg Med Clin North Am. 2016 May;34(2):377-86. Abstract

12. Spencer SP, Power N. The acute abdomen in the immune compromised host. Cancer Imaging. 2008 Apr 22;8:93-101.Full text  Abstract

13. Cervellin G, Mora R, Ticinesi A, et al. 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.Full text  Abstract

14. Hustey FM, Meldon SW, Banet GA, et al. The use of abdominal computed tomography in older ED patients with acute abdominal pain. Am J Emerg Med. 2005 May;23(3):259-65. Abstract

15. Foster NM, McGory ML, Zingmond DS, et al. Small bowel obstruction: a population-based appraisal. J Am Coll Surg. 2006 Aug;203(2):170-6. Abstract

16. Lopez-Kostner F, Hool GR, Lavery IC. Management and causes of acute large-bowel obstruction. Surg Clin North Am. 1997 Dec;77(6):1265-90. Abstract

17. Fagerström A, Paajanen P, Saarelainen H, et al. Non-specific abdominal pain remains as the most common reason for acute abdomen: 26-year retrospective audit in one emergency unit. Scand J Gastroenterol. 2017 Oct;52(10):1072-7. Abstract

18. Pennel DJ, Goergen N, Driver CP. Nonspecific abdominal pain is a safe diagnosis. J Pediatr Surg. 2014 Nov;49(11):1602-4. Abstract

19. Ferlander P, Elfström C, Göransson K, et al. Nonspecific abdominal pain in the emergency department: malignancy incidence in a nationwide Swedish cohort study. Eur J Emerg Med. 2018 Apr;25(2):105-9. Abstract

20. Ravn-Christensen C, Qvist N, Bay-Nielsen M, et al. Pathology is common in subsequent visits after admission for non-specific abdominal pain. Dan Med J. 2019 Jul;66(7):A5549. Abstract

21. Thim T, Krarup NH, Grove EL, et al. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med. 2012;5:117-21.Full text  Abstract

22. Dick F, Erdoes G, Opfermann P, et al. Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm. J Vasc Surg. 2013 Apr;57(4):943-50.Full text  Abstract

23. IMPROVE trial investigators., Powell JT, Hinchliffe RJ, et al. Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm. Br J Surg. 2014 Feb;101(3):216-24.Full text  Abstract

24. Escobar GA, Upchurch GR. Management of ruptured abdominal aortic aneurysms. In: Cameron JL, Cameron AM, eds. Current surgical therapy, 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:709-13.

25. Gayet-Ageron A, Prieto-Merino D, Ker K, et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. Lancet. 2018 Jan 13;391(10116):125-32.Full text  Abstract

26. Bruyninckx R, Aertgeerts B, Bruyninckx P, et al. Signs and symptoms in diagnosing acute myocardial infarction and acute coronary syndrome: a diagnostic meta-analysis. Br J Gen Pract. 2008 Feb;58(547):105-11.Full text  Abstract

27. Yamashita S, Tago M, Katsuki NE, et al. Relationships between sites of abdominal pain and the organs involved: a prospective observational study. BMJ Open. 2020 Jun 22;10(6):e034446.Full text  Abstract

28. Akbulut S, Caliskan A, Ekin A, et al. Left-sided acute appendicitis with situs inversus totalis: review of 63 published cases and report of two cases. J Gastrointest Surg. 2010 Sep;14(9):1422-8. Abstract

29. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018 Feb;22(1):1-165.Full text  Abstract

30. Benabbas R, Hanna M, Shah J, et al. Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2017 May;24(5):523-51.Full text  Abstract

31. Snyder MJ, Guthrie M, Cagle S. Acute appendicitis: efficient diagnosis and management. Am Fam Physician. 2018 Jul 1;98(1):25-33.Full text  Abstract

32. Scott AJ, Mason SE, Arunakirinathan M, et al. Risk stratification by the Appendicitis Inflammatory Response score to guide decision-making in patients with suspected appendicitis. Br J Surg. 2015 Apr;102(5):563-72. Abstract

33. Kharbanda AB, Vazquez-Benitez G, Ballard DW, et al. Development and validation of a novel Pediatric Appendicitis Risk Calculator (pARC). Pediatrics. 2018 Apr;141(4).Full text  Abstract

34. Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013 Sep;108(9):1400-16.Full text  Abstract

35. Choosing Wisely. American Society for Clinical Pathology: testing for amylase. 14 Sep 2016 [internet publication].Full text

36. Rompianesi G, Hann A, Komolafe O, et al. Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis. Cochrane Database Syst Rev. 2017 Apr 21;(4):CD012010.Full text  Abstract

37. Avanesov M, Löser A, Keller S, et al. Diagnosing acute pancreatitis - clinical and radiological characterisation of patients without threefold increase of serum lipase. Eur J Radiol. 2017 Oct;95:278-85. Abstract

38. American College of Radiology. ACR Appropriateness Criteria: acute nonlocalized abdominal pain. 2018 [internet publication].Full text  Abstract

39. Krajewski S, Brown J, Phang PT, et al. Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis. Can J Surg. 2011 Feb;54(1):43-53.Full text  Abstract

40. American College of Radiology. ACR appropriateness criteria: right lower quadrant pain. 2022 [internet publication].Full text

41. American College of Radiology. ACR Appropriateness Criteria: left lower quadrant pain-suspected diverticulitis. 2018 [internet publication].Full text  Abstract

42. National Institute for Health and Care Excellence. Diverticular disease: diagnosis and management. 27 Nov 2019 [internet publication].Full text

43. Rud B, Vejborg TS, Rappeport ED, et al. Computed tomography for diagnosis of acute appendicitis in adults. Cochrane Database Syst Rev. 2019 Nov 19;(11):CD009977.Full text  Abstract

44. Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al. Diagnosis and management of acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians. Ann Intern Med. 18 Jan 2022 [Epub ahead of print].Full text  Abstract

45. Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32.Full text  Abstract

46. ACR Committee on Drugs and Contrast Media. ACR manual on contrast media. 2021 [internet publication].Full text

47. Barat M, Paisant A, Calame P, et al. Unenhanced CT for clinical triage of elderly patients presenting to the emergency department with acute abdominal pain. Diagn Interv Imaging. 2019 Nov;100(11):709-19.Full text  Abstract

48. Lindelius A, Törngren S, Pettersson H, et al. Role of surgeon-performed ultrasound on further management of patients with acute abdominal pain: a randomised controlled clinical trial. Emerg Med J. 2009 Aug;26(8):561-6. Abstract

49. Lindelius A, Törngren S, Nilsson L, et al. Randomized clinical trial of bedside ultrasound among patients with abdominal pain in the emergency department: impact on patient satisfaction and health care consumption. Scand J Trauma Resusc Emerg Med. 2009 Nov 27;17:60.Full text  Abstract

50. Oppenheimer DC, Rubens DJ. Sonography of acute cholecystitis and its mimics. Radiol Clin North Am. 2019 May;57(3):535-48. Abstract

51. Shur J, Bottomley C, Walton K, et al. Imaging of acute abdominal pain in the third trimester of pregnancy. BMJ. 2018 Jun 21;361:k2511. Abstract

52. American College of Radiology. ACR appropriateness criteria®: right upper quadrant pain. 2022 [internet publication].Full text

53. Mushtaq R, Desoky SM, Morello F, et al. First-line diagnostic evaluation with MRI of children suspected of having acute appendicitis. Radiology. 2019 Apr;291(1):170-7.Full text  Abstract

54. Gaitan HG, Reveiz L, Farquhar C, et al. Laparoscopy for the management of acute lower abdominal pain in women of childbearing age. Cochrane Database Syst Rev. 2014 May 22;(5):CD007683.Full text  Abstract

55. Dominguez LCS. Early laparoscopy for the evaluation of nonspecific abdominal pain: a critical appraisal of the evidence. Surg Endosc. 2011 Jan;25(1):10-8. Abstract

56. American College of Radiology. ACR Appropriateness Criteria: suspected small-bowel obstruction. 2019 [internet publication].Full text

57. Rami Reddy SR, Cappell MS. A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep. 2017 Jun;19(6):28. Abstract

58. Ceresoli M, Coccolini F, Catena F, et al. Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value. Am J Surg. 2016 Jun;211(6):1114-25. Abstract

59. Rabinovici R, Simansky DA, Kaplan O, et al. Cecal volvulus. Dis Colon Rectum. 1990 Sep;33(9):765-9. Abstract

60. Shaff MI, Himmelfarb E, Sacks GA, et al. The whirl sign: a CT finding in volvulus of the large bowel. J Comput Assist Tomogr. 1985 Mar-Apr;9(2):410. Abstract

61. Sorantin E, Lindbichler F. Management of intussusception. Eur Radiol. 2004 Mar;14(suppl 4):L146-54. Abstract

62. del-Pozo G, Albillos JC, Tejedor D, et al. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics. 1999 Mar-Apr;19(2):299-319. Abstract

63. Shiels WE 2nd, Maves CK, Hedlund GL, et al. Air enema for diagnosis and reduction of intussusception: clinical experience and pressure correlates. Radiology. 1991 Oct;181(1):169-72. Abstract

64. American College of Radiology. ACR-SPR practice parameter for the performance of pediatric fluoroscopic contrast enema examinations. 2016 [internet publication].Full text

65. Byrne AT, Geoghegan T, Govender P, et al. The imaging of intussusception. Clin Radiol. 2005 Jan;60(1):39-46. Abstract

66. Ko CW, Lee SP. Gastrointestinal disorders of the critically ill: biliary sludge and cholecystitis. Best Pract Res Clin Gastroenterol. 2003 Jun;17(3):383-96. Abstract

67. Ziessman HA. Acute cholecystitis, biliary obstruction, and biliary leakage. Semin Nucl Med. 2003 Oct;33(4):279-96. Abstract

68. Jansen S, Stodolski M, Zirngibl H, et al. Advanced gallbladder inflammation is a risk factor for gallbladder perforation in patients with acute cholecystitis. World J Emerg Surg. 2018 Feb 20;13:9.Full text  Abstract

69. Mirvis SE, Vainright JR, Nelson AW, et al. The diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT. AJR Am J Roentgenol. 1986 Dec;147(6):1171-5. Abstract

70. Shuman WP, Rogers JV, Rudd TG, et al. Low sensitivity of sonography and cholescintigraphy in acalculous cholecystitis. AJR Am J Roentgenol. 1984 Mar;142(3):531-4. Abstract

71. Søreide K, Thorsen K, Harrison EM, et al. Perforated peptic ulcer. Lancet. 2015 Sep 26;386(10000):1288-98.Full text  Abstract

72. Tomtitchong P, Siribumrungwong B, Vilaichone RK, et al. Systematic review and meta-analysis: Helicobacter pylori eradication therapy after simple closure of perforated duodenal ulcer. Helicobacter. 2012 Apr;17(2):148-52. Abstract

73. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 2017 Jan;66(1):6-30.Full text  Abstract

74. Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004 Jan;91(1):28-37. Abstract

75. Ortega-Deballon P, Ruiz de Adana-Belbel JC, Hernández-Matías A, et al. Usefulness of laboratory data in the management of right iliac fossa pain in adults. Dis Colon Rectum. 2008 Jul;51(7):1093-9.Full text  Abstract

76. Chen SC, Chen KM, Wang SM, et al. Abdominal sonography screening of clinically diagnosed or suspected appendicitis before surgery. World J Surg. 1998 May;22(5):449-52. Abstract

77. Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update. 2014 Mar-Apr;20(2):250-61.Full text  Abstract

78. Servaes S, Zurakowski D, Laufer MR, et al. Sonographic findings of ovarian torsion in children. Pediatr Radiol. 2007 May;37(5):446-51. Abstract

79. Nienaber CA, Powell JT. Management of acute aortic syndromes. Eur Heart J. 2012 Jan;33(1):26-35b.Full text  Abstract

80. American College of Radiology. ACR Appropriateness Criteria: nontraumatic aortic disease. 2020 [internet publication].Full text

81. Kuhn M, Bonnin RL, Davey MJ, et al. Emergency department ultrasound scanning for abdominal aortic aneurysm: accessible, accurate, and advantageous. Ann Emerg Med. 2000 Sep;36(3):219-23. Abstract

82. Kanasaki S, Furukawa A, Fumoto K, et al. Acute mesenteric ischemia: multidetector CT findings and endovascular management. Radiographics. 2018 May-Jun;38(3):945-61.Full text  Abstract

83. Mohammed MF, Elbanna KY, Mohammed AME, et al. Practical applications of dual-energy computed tomography in the acute abdomen. Radiol Clin North Am. 2018 Jul;56(4):549-63. Abstract

84. Murray MJ, Gonze MD, Nowak LR, et al. Serum D(-)-lactate levels as an aid to diagnosing acute intestinal ischemia. Am J Surg. 1994 Jun;167(6):575-8. Abstract

85. Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. Gastroenterology. 2000 May;118(5):954-68.Full text  Abstract

86. Yudin MH, Hillier SL, Wiesenfeld HC, et al. Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease. Am J Obstet Gynecol. 2003 Feb;188(2):318-23. Abstract

87. Mirhashemi R, Schoell WM, Estape R, et al. Trends in the management of pelvic abscesses. J Am Coll Surg. 1999 May;188(5):567-72. Abstract

88. Taylor KJ, Wasson JF, De Graaff C, et al. Accuracy of grey-scale ultrasound diagnosis of abdominal and pelvic abscesses in 220 patients. Lancet. 1978 Jan 14;1(8055):83-4. Abstract

89. Badalov N, Baradarian R, Iswara K, et al. Drug-induced acute pancreatitis: an evidence-based review. Clin Gastroenterol Hepatol. 2007 Jun;5(6):648-61. Abstract

90. Tenner S, Dubner H, Steinberg W. Predicting gallstone pancreatitis with laboratory parameters: a meta-analysis. Am J Gastroenterol. 1994 Oct;89(10):1863-6. Abstract

91. Stollman NH, Raskin JB; Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Diagnosis and management of diverticular disease of the colon in adults. Am J Gastroenterol. 1999 Nov;94(11):3110-21.Full text  Abstract

92. Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management -- a prospective study of 542 patients. Eur Radiol. 2002 May;12(5):1145-9. Abstract

93. Stefánsson T, Nyman R, Nilsson S, et al. Diverticulitis of the sigmoid colon. A comparison of CT, colonic enema and laparoscopy. Acta Radiol. 1997 Mar;38(2):313-9. Abstract

94. Verbanck J, Lambrecht S, Rutgeerts L, et al. Can sonography diagnose acute colonic diverticulitis in patients with acute intestinal inflammation? A prospective study. J Clin Ultrasound. 1989 Nov-Dec;17(9):661-6. Abstract

95. Zielke A, Hasse C, Nies C, et al. Prospective evaluation of ultrasonography in acute colonic diverticulitis. Br J Surg. 1997 Mar;84(3):385-8. Abstract

96. Ahmed O, Rodrigues DM, Nguyen GC. Magnetic resonance imaging of the small bowel in Crohn's disease: a systematic review and meta-analysis. Can J Gastroenterol Hepatol. 2016;2016:7857352.Full text  Abstract

97. Ross M, Brown M, McLaughlin K, et al. Emergency physician-performed ultrasound to diagnose cholelithiasis: a systematic review. Acad Emerg Med. 2011 Mar;18(3):227-35.Full text  Abstract

98. ASGE Standards of Practice Committee, Buxbaum JL, Abbas Fehmi SM, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc. 2019 Jun;89(6):1075-1105;e15. Abstract

99. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral. Dec 2021 [internet publication].Full text

100. Forrester JD, Cha P, Tennakoon L, et al. Tuberculosis and the acute abdomen: an evaluation of the national inpatient sample. Surg Infect (Larchmt). 2020 Mar;21(2):94-100. Abstract

101. Rushworth RL, Torpy DJ, Falhammar H. Adrenal crisis. N Engl J Med. 2019 Aug 29;381(9):852-61. Abstract

102. Straley CM, Cecil EJ, Herriman MP. Gatifloxacin interference with opiate urine drug screen. Pharmacotherapy. 2006 Mar;26(3):435-9. Abstract

103. de Paula M, Saiz LC, González-Revaldería J, et al. Rifampicin causes false-positive immunoassay results for urine opiates. Clin Chem Lab Med. 1998 Apr;36(4):241-3. Abstract

104. Simon E, Long B, Koyfman A. Emergency medicine management of sickle cell disease complications: an evidence-based update. J Emerg Med. 2016 Oct;51(4):370-81. Abstract

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