Surgical emergencies: acute abdominal pain (Part 2)
Adam Jones, Kevin Turner, and Ashok Handa continue to explain the treatment of patients in acute pain
In last month's article we explained how to deal with a call from an accident and emergency department to see a patient with severe undiagnosed acute abdominal pain. This month we consider three specific surgical abdominal emergencies: ruptured abdominal aortic aneurysm, perforated viscus, and pancreatitis.
Abdominal aortic aneurysms are important because they are common. About 1% of all men over 65 years have an abdominal aortic aneurysm, and if this ruptures mortality is over 50% - and that is only in the people who survive long enough to reach hospital.1
This diagnosis must not be missed because minutes matter. So when you see a patient in accident and emergency with abdominal pain who looks terrible, specifically try to exclude this diagnosis. Is the patient elderly? Is s/he known to have an abdominal aortic aneurysm? Is the pain radiating to the back and of sudden onset? The diagnosis is confirmed if