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Acute abdomen implies a set of different clinical conditions which, due to its severity and unpredictable course of the disease, very often require immediate diagnostic and therapeutic procedures, including emergency surgery. Due to its complexity, despite numerous diagnostic possibilities, it still represents one of the most common dilemmas in the emergency medicine. The main feature of acute abdomen is pain, and it is estimated that between 5 and 10% of all visits to the emergency department are related to acute abdominal pain, which is one of the most common reasons for a patient to visit a doctor. Since the approach to patients with acute abdominal pain varies and mainly depends on the views of doctors, the goal of these guidelines is to create a standardized approach that will enable faster diagnosis, optimization of therapy and improvement of the quality of care for these patients in emergency medicine. The guidelines were created as a result of the cooperation of the members of the Croatian Society for Emergency Medicine – Croatian Medical Association and the Croatian Society for Digestive Surgery – Croatian Medical Association. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is one of the most common acute abdominal diseases in clinical practice, and the common etiologies of acute pancreatitis include biliary diseases, alcohol, pancreatic duct diseases, metabolic disorders (hypertriglyceridemia and hypercalcemia), excessive eating, and diseases of the descending duodenum (periampullary duodenal diverticula). According to the etiology, acute pancreatitis is classified into biliary pancreatitis and hyperlipidemic pancreatitis, and although there are various pathogenic factors for biliary pancreatitis, biliary diseases including bile duct stones remain the most important etiology of biliary pancreatitis. Obstructed biliopancreatic duct drainage and abnormal pressure due to various causes, bile reflux into the pancreatic duct, obstruction of pancreatic juice drainage, and abnormal activation of pancreatic enzymes are the central links in the development of biliary pancreatitis. The location, size, texture, number and shape of bile duct stones are associated with the incidence rate and severity of biliary pancreatitis to a certain degree. [ABSTRACT FROM AUTHOR]

Lymphangiomas are rare benign tumors that mainly involve the head and neck region in pediatric patients. Lymphangiomas of the small bowel mesentery in adults are rarer. We present two cases of mesenteric lymphangioma with acute abdominal pain on presentation. Case 1: A 38-year-old female presented with abdominal pain, vomiting, fever, and difficult evacuation. On abdominal examination, she had an ill-defined, tender lump, and radiological findings raised a possibility of perforation peritonitis. Thus, exploratory laparotomy was planned. Per-operatively, a mesenteric mass was found, which, on histopathological evaluation, was found to be a mesenteric lymphangioma involving the bowel. Case 2: A 27-year-old male presented with abdominal pain and difficult evacuation. Radiological evaluation revealed a multilobulated lesion involving the mesentery and with differential diagnoses of mesenteric fibromatoses and inflammatory pseudotumor. Histopathological assessment of the resected mass revealed a lymphangioma that was limited to the mesentery. Owing to their rarity and non-specific presentation, mesenteric lymphangiomas are often misdiagnosed on clinical examination and imaging. Thus, histopathological examination is the gold standard to reach a definitive diagnosis.

Ectopia of intrauterine device (IUD) is a complication of contraception. The case was reported that a 33-year-old woman who had been placed with an IUD for 6 years and had a sudden acute abdominal pain after sex life. Acute pelvic inflammatory disease was initially considered. After 4 days of anti-infection treatment after admission, abdominal pain was not relieved. The imaging examination indicated the enlargement of pelvic mass, so exploratory laparotomy was performed. The final diagnosis was ectopic IUD, uterine perforation, intestinal perforation, and endometrioid cyst of ovarian. Combined with the literature review on ectopic IUD and gynecological acute abdominal pain, the clinical data of this case was presented in order to improve the attention and understanding of clinicians on acute abdominal pain and to treat timely these patients. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND: Clinical features and outcomes of patients admitted to the intensive care unit due to acute abdomen are important to be investigated. AIMS: To evaluate the outcomes of critically ill subjects with acute abdomen according to etiology, comorbidity and severity. METHODS: Outcomes of 1,523 patients (878 women, mean age 66±18 years) consecutively admitted to a specialized gastrointestinal intensive care unit with different causes of acute abdomen from January 2012 to December 2019, were retrospectively evaluated according to etiology, comorbidity and severity. RESULTS: The most common causes of acute abdomen were obstructive and inflammatory, particularly large bowel obstruction (27%), small bowel obstruction (18%) and acute pancreatitis (17%). Overall mortality was 13%. Surgery was required in 34% of patients. Median length of stay in the hospital was 9 [1-101] days. On univariate analysis mortality was significantly associated with age, APACHE II, Charlson comorbidity index, requirement for surgery and malignancy (p

Background Acute abdominal pain is one of the most common chief complaints in medical emergencies. Due to atypical clinical manifestations, the misdiagnosis rate of acute abdominal pain caused by vascular diseases is high. Objective To assess the value of the checklist of abdominal pain causes in the differential diagnosis of vascular diseases with abdominal pain as a presentation. Methods In accordance with the five diseases (localized organic disease, heart, lung and spine diseases, systemic disease, functional disorders, gynecological disease) with abdominal pain as a manifestation in the checklist of abdominal pain causes, we analyzed the causes of abdominal pain in three patients with acute atypical abdominal pain as the main manifestation for making a proper diagnosis, then assessed the practicability of the checklist in the diagnosis of vascular diseases. Results With the help of the checklist, the time used for diagnosing one patient with acute renal infarction, one with aortic dissection, and the other with pulmonary embolism was 1.5, 1.5, 1.75 hours, respectively. All the patients received timely diagnosis and treatment. Conclusion The checklist is helpful to the differential diagnosis of vascular abdominal pain, making a rapid clinical diagnosis, and forming a systematic diagnostic thinking mode.