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What are some other nonsurgical causes of acute abdomen?
The list of medical causes of acute abdominal pain is long and can often cause diagnostic dilemmas if the index of suspicion is low.
It includes diabetic ketoacidosis, hypercalcemia, myocardial infarction, pneumonia, ureteral calculi, and gastroenteritis.
Careful history, repeat examinations, and judicious use of diagnostic imaging are paramount to avoid unnecessary surgery.
The simulation of an acute surgical lesion in the abdomen by a medical condition is not uncommon. Tabes dorsalis, plumbism, herpes zoster, spondylitis, and coronary occlusion are examples of common medical conditions which not infrequently present abdominal symptoms closely resembling those of acute appendicitis, ruptured ulcer, or calculous cholecystitis.
The abdomen has repeatedly been opened and no pathological lesion found, while, at a later date, laboratory evidence of diabetic acidosis or of plumbism was returned. The surgeon or internist must be alert to the possibilities applying to his particular case before subjecting a patient with atypical abdominal findings to an unnecessary exploratory laparotomy.
Practically no abdominal condition is such an emergency as to preclude a white blood count and urinalysis (sugar, albumin, and microscopical).
A classification of the medical conditions causing acute abdominal pain, which may, on occasions, be confused with surgical entities, is presented below.
Such a list is not all inclusive, nor does it contain those conditions which usually lead to surgical intervention at a later date (e.g., stone in the genito-urinary tract, biliary colic, etc.).
Non-surgical Causes of Acute Abdominal Pain:
(1) Metabolic
(a) Diabetic acidosis.
(b) Tetany.
(2) Cardiovascular
(a) Referred from the heart (angina pectoris, coronary occlusion, pericarditis).
(b) Embolism and thrombosis (mesenteric occlusion, subacute bacterial endocarditis, polycythemia).
(c) Intra-abdominal arterial disease (periarteritis nodosa, dissecting aneurism, abdominal angina).
(3) Haematologic
(a) Hæmolytic icterus.
(b) Purpura (Henoch, Osler).
(c) Sickle-cell anaemia.
(d) Splenic enlargements with perisplenitis or infarction (leukemia, Banti’s disease, Hodgkin’s disease, etc.).
(4) Infectious
(a) Occasionally at onset of acute infections (influenza, typhoid and paratyphoid fevers, poliomyelitis, malaria, acute tonsillitis).
Sources
- Comroe BI. NON-SURGICAL CAUSES OF ACUTE ABDOMINAL PAIN. Ann Surg. 1935 Jan;101(1):438-44. doi: 10.1097/00000658-193501000-00047. PMID: 17856468; PMCID: PMC1391121.https://pmc.ncbi.nlm.nih.gov/articles/PMC1391121/
