Management of acute abdomen: Study of 110 cases

Background: The term acute abdomen designates symptoms and signs of intraabdominal diseases usually treated best by surgical operation. Many diseases, some of which do not require surgical treatment, produce abdominal pain, so the evaluation of patients with abdominal pain must be methodical and careful. The proper management of patients with acute abdominal pain requires a timely decision about the need for surgical operation. The term “acute abdomen” should never be equated with the invariable need for operation. The abdomen has been referred to as Pandora’s magic box. Very often an accurate diagnosis cannot be made without surgery and many wonders are revealed on opening the abdomen. So it is often the last court of appeal in investigating abdominal cases. The general rule can be laid down that the majority of severe abdominal pains that ensue in patients who have been previously well, and that last as long as six hours, are caused by conditions of surgical import. Materials and methods: The present study was a study of 110 patients presenting with acute abdominal pain. Out of these, 100 patients were managed surgically and 10 patients were kept conservatively. Sampling frame was done to study the incidence of non-traumatic, acute abdominal emergencies. Inclusion criteria were patients willing to participate in the study, patients with history of acute onset of pain in abdomen, positive findings in USG and X-ray abdomen standing. Results: From 61-70 years of age, 11 total cases were reported, out of which 5 were due to perforated duodenal ulcer, 2 each due to ileal perforation and gastric perforation, and 1 each for acute intestinal obstruction and acute pancreatitis. Out of 110 cases of acute abdomen, 42 were caused by acute appendicitis and hence it forms the major reason among the causes of acute abdomen. While comparing duration of pain and acute abdomen with its management, it was found that when the pain was less than 8 hours long, the final diagnosis of acute abdomen was obtained in 21 patients out of a total of 110. This formed 19% of the total cases. A Maximum of 15 cases of complications were seen in acute intestinal obstruction with 6 wound infections, 5 pulmonary complications , 2 cases of septicemia and 2 cases of skin excoriation. Also death of a patient was seen. This disease forms 13% of the total cases. Conclusion: Acute abdomen is often a surgical emergency and a challenge to any surgeon. Rigorous approach to diagnose is mandatory. Acute appendicitis was the most common cause of abdominal surgical emergency.