ACUTE ABDOMEN

When Abdominal Pain Becomes a Medical Emergency

A guide to recognizing dangerous abdominal symptoms before it is too late

Nearly everyone experiences abdominal pain at some point in life. Most cases result from indigestion, food poisoning, acid reflux, or minor gastrointestinal disturbances and resolve without serious consequences. However, a small but critically important group of patients develop what physicians call an acute abdomen—a potentially life-threatening condition requiring urgent medical evaluation and, in many cases, emergency surgery.

The challenge is that dangerous abdominal conditions often begin with symptoms that appear deceptively ordinary. A stomachache dismissed as “kabag” may actually be appendicitis. A painful gallbladder attack may progress to severe infection. A perforated ulcer, ruptured ectopic pregnancy, intestinal obstruction, or abdominal aneurysm can rapidly become fatal if treatment is delayed.

Knowing when abdominal pain is merely uncomfortable—and when it is dangerous—can save lives.

By Rafael R. Castillo, MD

THE NIGHT THE PAIN WOULD NOT GO AWAY

At midnight, a 38-year-old office worker awakens with abdominal discomfort near the navel.

He assumes it is something he ate.

He takes antacids.

The pain persists.

By dawn, the discomfort has migrated to the lower right side of the abdomen. Walking hurts. Nausea develops.

Still, he delays consultation.

“Masakit lang ang tiyan.” (It’s just a stomach ache.)

Several hours later, he arrives in the emergency room.

His appendix has ruptured.

The surgery becomes more complicated. Recovery becomes longer.

This scenario plays out every day in hospitals across the Philippines.

WHAT IS AN ACUTE ABDOMEN?

Acute abdomen refers to the sudden onset of severe abdominal pain that may signal a serious intra-abdominal disease requiring urgent medical or surgical treatment.

It is not a diagnosis itself.

Rather, it is a warning sign.

The challenge for physicians is determining whether the pain represents a minor condition—or a potentially life-threatening emergency.

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“Not every stomachache is dangerous. But some abdominal pains are the body’s alarm system signaling a medical emergency.”

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WHY THE ABDOMEN IS SO DIFFICULT TO INTERPRET

The abdomen houses numerous organs:

• Stomach
• Intestines
• Liver
• Gallbladder
• Pancreas
• Appendix
• Kidneys
• Urinary tract
• Major blood vessels
• Reproductive organs

Pain from these structures can overlap.

This explains why abdominal diagnosis sometimes resembles detective work.

COMMON CAUSES OF ACUTE ABDOMEN IN FILIPINOS

1. Acute Appendicitis

One of the most common surgical emergencies.

Typical Symptoms

✔ Pain beginning around the navel

✔ Pain migrating to the lower right abdomen

✔ Fever

✔ Nausea

✔ Loss of appetite

Delayed treatment may result in rupture.

2. Acute Cholecystitis (Gallbladder Infection)

Often related to gallstones.

Symptoms

✔ Right upper abdominal pain

✔ Pain after fatty meals

✔ Nausea

✔ Fever

Pain may radiate to the back or shoulder.

3. Acute Pancreatitis

Inflammation of the pancreas.

Common causes:

• Gallstones
• Excessive alcohol use
• Elevated triglycerides

Symptoms

✔ Severe upper abdominal pain

✔ Pain radiating to the back

✔ Vomiting

4. Intestinal Obstruction

The bowel becomes blocked.

Causes include:

• Previous surgery
• Hernias
• Tumors
• Severe inflammation

Symptoms

✔ Abdominal swelling

✔ Vomiting

✔ Inability to pass stool or gas

5. Perforated Peptic Ulcer

An ulcer creates a hole in the stomach or intestine.

Symptoms

✔ Sudden severe pain

✔ Rigid abdomen

✔ Rapid deterioration

This is a true surgical emergency.

6. Diverticulitis

Inflammation of intestinal pouches.

More common among older adults.

7. Kidney Stones

Can produce severe flank and abdominal pain.

Patients often appear restless and unable to find a comfortable position.

8. Ectopic Pregnancy

A life-threatening emergency affecting women of childbearing age.

Symptoms

✔ Lower abdominal pain

✔ Vaginal bleeding

✔ Dizziness

Immediate evaluation is critical.

WHEN SHOULD YOU CALL YOUR DOCTOR?

Consult within 24 hours if:

✔ Pain lasts more than several hours

✔ Symptoms are worsening

✔ Fever develops

✔ Appetite disappears completely

✔ Pain interferes with normal activities

THE LOCATION OF PAIN CAN OFFER CLUES

Upper Right Abdomen

May suggest:

• Gallbladder disease
• Liver disease

Upper Middle Abdomen

May suggest:

• Gastritis
• Ulcer disease
• Pancreatitis

Lower Right Abdomen

May suggest:

• Appendicitis

Lower Left Abdomen

May suggest:

• Diverticulitis

Flank Pain

May suggest:

• Kidney stones
• Kidney infection

HOW DO DOCTORS DIAGNOSE ACUTE ABDOMEN?

Diagnosis begins with:

Detailed History

• Location
• Duration
• Character of pain
• Associated symptoms

Physical Examination

Physicians look for:

✔ Tenderness

✔ Guarding

✔ Rebound tenderness

✔ Abdominal rigidity

Laboratory Tests

Common tests include:

• CBC

• Electrolytes

• Liver enzymes

• Pancreatic enzymes

• Urinalysis

• Pregnancy testing when appropriate

Imaging Studies

Depending on the situation:

✔ Ultrasound

✔ CT Scan

✔ MRI

✔ X-rays

MODERN IMAGING HAS SAVED COUNTLESS LIVES

Decades ago, diagnosis relied largely on clinical judgment.

Today, CT scans and ultrasound significantly improve accuracy.

They help identify:

• Appendicitis

• Gallstones

• Bowel obstruction

• Abscesses

• Perforation

• Tumors

TREATMENT DEPENDS ON THE CAUSE

Not every acute abdomen requires surgery.

Treatment may involve:

✔ Antibiotics

✔ IV fluids

✔ Pain management

✔ Observation

✔ Surgery when necessary

THE DANGER OF SELF-MEDICATION

Many Filipinos delay consultation because:

• “Baka kabag lang.” (It’s probably just gas.)

• “Maghihilot muna ako.” (I’ll try massaging.)

• “Subukan ko muna itong herbal.” (I’ll try herbal medicines.)

Unfortunately, dangerous abdominal conditions often worsen during these delays.

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“The greatest danger is not abdominal pain itself—but assuming it will simply go away.”

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WHAT CAN FAMILIES DO?

If severe abdominal pain develops:

✔ Monitor symptoms carefully

✔ Seek medical evaluation early

✔ Note associated symptoms

✔ Avoid delaying consultation

✔ Bring medication history

FINAL REFLECTION

Abdominal pain is among the most common reasons people seek medical care.

Fortunately, most cases are not dangerous.

Yet hidden among countless episodes of indigestion and stomach upset are conditions that can rapidly become life-threatening.

The challenge is knowing the difference.

The body often gives warning signs before disaster strikes.

Fever.

Vomiting.

Persistent pain.

Sudden worsening.

These symptoms deserve respect.

Because when it comes to acute abdomen, early recognition and timely medical attention often make the difference between a straightforward recovery and a life-threatening emergency.

REFERENCES

1. American College of Surgeons. Acute Abdomen Guidelines. 2024.
2. American College of Gastroenterology. Evaluation of Acute Abdominal Pain. 2024.
3. Tintinalli JE. Emergency Medicine: A Comprehensive Study Guide. 10th Edition.
4. Sabiston Textbook of Surgery. 22nd Edition.
5. World Society of Emergency Surgery Guidelines. Acute Abdomen Management. 2023.
6. American Family Physician. Evaluation of Acute Abdominal Pain in Adults.
7. UpToDate. Approach to Acute Abdominal Pain in Adults. Updated 2025.
8. World Health Organization. Emergency Surgical Care Manual.
9. Philippine College of Surgeons Clinical Practice Resources.
10. Philippine Society of Gastroenterology Educational Materials.