Current Trends in the Diagnosis and Management of Acute Abdomen in Emergency Surgery
DOI:
https://doi.org/10.56981/M512Keywords:
Acute abdomen; Emergency general surgery; Diagnostic imaging; Damage control surgery; Sepsis and source controlAbstract
Background: Acute abdomen in emergency surgery remains a high-risk, heterogeneous syndrome in which delayed recognition of ischemia, perforation, obstruction, or complicated intra-abdominal infection can rapidly translate into preventable morbidity and mortality. Diagnostic uncertainty is magnified by changing case-mix, including frailty, multimorbidity, immunosuppression, pregnancy, and chronic anticoagulation.
Objective: To synthesize current trends in diagnostics, management, and systems of care for emergency general surgery presentations with acute abdominal pain.
Sources of evidence: PubMed/MEDLINE and the Cochrane Library were searched for relevant evidence from 2020–2026, complemented by international guideline and consensus documents (e.g., WSES, Surviving Sepsis Campaign, ACR Appropriateness Criteria, and emergency-surgery ERAS guidance).
Content: Diagnostic trends emphasize pathway-based imaging, with CT as the principal modality in many adult presentations, increased use of protocolized contrast strategies and CT angiography for suspected mesenteric ischemia, and broader integration of bedside ultrasound/POCUS when CT is delayed or unsuitable. Biomarkers and risk scores are increasingly used as adjuncts within decision pathways rather than stand-alone tests. Management trends include more selective non-operative strategies for uncomplicated syndromes, earlier laparoscopy in appropriate candidates, and clearer thresholds for conversion or open surgery when physiology deteriorates or ischemia/contamination is suspected. Cross-cutting operative trends highlight damage control surgery for physiologic exhaustion, sepsis-aligned resuscitation with timely source control, and perioperative optimization using emergency-adapted ERAS principles.
References
1. Arshava EV. The Acute Abdomen. Hamilton Bailey’s Demonstrations of Physical Signs in Clinical Surgery: CRC Press; 2016. p. 577-614.
2. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(1):27.
3. Sartelli M, Weber DG, Kluger Y, Ansaloni L, Coccolini F, Abu-Zidan F, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020;15(1):32.
4. Costa G, Fransvea P, Puccioni C, Giovinazzo F, Carannante F, Bianco G, et al. Gastro-intestinal emergency surgery: Evaluation of morbidity and mortality. Protocol of a prospective, multicenter study in Italy for evaluating the burden of abdominal emergency surgery in different age groups.(The GESEMM study). Frontiers in surgery. 2022;9:927044.
5. De Pascale G, Carelli S, Vallecoccia MS, Cutuli SL, Taccheri T, Montini L, et al. Risk factors for mortality and cost implications of complicated intra-abdominal infections in critically ill patients. Journal of critical care. 2019;50:169-76.
6. Sartelli M, Tascini C, Coccolini F, Dellai F, Ansaloni L, Antonelli M, et al. Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use. World Journal of Emergency Surgery. 2024;19(1):23.
7. Sala E, Watson C, Beadsmoore C, Groot-Wassink T, Fanshawe T, Smith J, et al. A randomized, controlled trial of routine early abdominal computed tomography in patients presenting with non-specific acute abdominal pain. Clinical radiology. 2007;62(10):961-9.
8. Dumbrava B-D. Point Of Care Ultrasound By Surgeons: A Multicentric Trial (POCUSS Trial): Royal College of Surgeons in Ireland; 2022.
9. Coccolini F, Sartelli M, Sawyer R, Rasa K, Viaggi B, Abu-Zidan F, et al. Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines. World J Emerg Surg. 2023;18(1):41.
10. de Almeida Leite RM, Seo DJ, Gomez-Eslava B, Hossain S, Lesegretain A, de Souza AV, et al. Nonoperative vs operative management of uncomplicated acute appendicitis: a systematic review and meta-analysis. JAMA surgery. 2022;157(9):828-34.
11. Ten Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2018;13:24.
12. Tian BW, Stahel PF, Picetti E, Campanelli G, Di Saverio S, Moore E, et al. Assessing and managing frailty in emergency laparotomy: a WSES position paper. World journal of emergency surgery. 2023;18(1):38.
13. Peden CJ, Aggarwal G, Aitken RJ, Anderson ID, Bang Foss N, Cooper Z, et al. Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization. World J Surg. 2021;45(5):1272-90.
14. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Critical care medicine. 2021;49(11):e1063-e143.
15. Rastrollo RH, Enríquez VS. Acute abdomen. Pediatría Integral. 2024;7:17.
16. Bala M, Catena F, Kashuk J, De Simone B, Gomes CA, Weber D, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World journal of emergency surgery. 2022;17(1):54.
17. Bower KL, Lollar DI, Williams SL, Adkins FC, Luyimbazi DT, Bower CE. Small bowel obstruction. Surgical Clinics. 2018;98(5):945-71.
18. Bala M, Catena F, Kashuk J, De Simone B, Gomes CA, Weber D, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022;17(1):54.
19. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-247.
20. Park JH, Salminen P, Tannaphai P, Lee KH. Low-Dose Abdominal CT for Evaluating Suspected Appendicitis in Adolescents and Young Adults: Review of Evidence. Korean J Radiol. 2022;23(5):517-28.
21. Wilson SJ, Thavanathan R, Cheng W, Stuart J, Kim DJ, Glen P, et al. Test Characteristics of Emergency Medicine-Performed Point-of-Care Ultrasound for the Diagnosis of Acute Cholecystitis: A Systematic Review and Meta-analysis. Ann Emerg Med. 2024;83(3):235-46.
22. Duque GA, Lotfollahzadeh S. Appendicitis in pregnancy. StatPearls. 2023.
23. Sermonesi G, Tian B, Vallicelli C, Abu-Zidan FM, Damaskos D, Kelly MD, et al. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma. World J Emerg Surg. 2023;18(1):57.
24. Coccolini F, Sartelli M, Sawyer R, Rasa K, Viaggi B, Abu-Zidan F, et al. Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines. World journal of emergency surgery. 2023;18(1):41.
25. Flum DR, Davidson GH, Monsell SE, Shapiro NI, Odom SR, Sanchez SE, et al. A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis. N Engl J Med. 2020;383(20):1907-19.
26. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):55-72.
27. Loozen CS, van Santvoort HC, van Duijvendijk P, Besselink MG, Gouma DJ, Nieuwenhuijzen GA, et al. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. bmj. 2018;363.
28. Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, Fitterman N, Shamliyan T, Wilt TJ, et al. Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians. Ann Intern Med. 2022;175(3):399-415.
29. Tarasconi A, Coccolini F, Biffl WL, Tomasoni M, Ansaloni L, Picetti E, et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg. 2020;15:3.
30. Tenner S, Vege SS, Sheth SG, Sauer B, Yang A, Conwell DL, et al. American College of Gastroenterology Guidelines: Management of Acute Pancreatitis. Am J Gastroenterol. 2024;119(3):419-37.
31. Coccolini F, Roberts D, Ansaloni L, Ivatury R, Gamberini E, Kluger Y, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2018;13:7.
32. Haltmeier T, Falke M, Quaile O, Candinas D, Schnüriger B. Damage-control surgery in patients with nontraumatic abdominal emergencies: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2022;92(6):1075-85.
33. Pucher P, Mackenzie H, Tucker V, Mercer S. A national propensity score-matched analysis of emergency laparoscopic versus open abdominal surgery. British Journal of Surgery. 2021;108(8):934-40.
34. Tian B, Stahel PF, Picetti E, Campanelli G, Di Saverio S, Moore E, et al. Assessing and managing frailty in emergency laparotomy: a WSES position paper. World J Emerg Surg. 2023;18(1):38.
35. Scott MJ, Aggarwal G, Aitken RJ, Anderson ID, Balfour A, Foss NB, et al. Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS(®)) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care. World J Surg. 2023;47(8):1850-80.
36. ACOG Committee Opinion No. 775: Nonobstetric Surgery During Pregnancy. Obstet Gynecol. 2019;133(4):e285-e6.
37. Kenington JC, Pellino G, Iqbal MR, Ahmed N, Halahakoon VC, Zaborowski AM, et al. Guidelines on general surgical emergencies in pregnancy. British Journal of Surgery. 2024;111(3):znae051.
38. Ball E, Waters N, Cooper N, Talati C, Mallick R, Rabas S, et al. Evidence-Based Guideline on Laparoscopy in Pregnancy: Commissioned by the British Society for Gynaecological Endoscopy (BSGE) Endorsed by the Royal College of Obstetricians & Gynaecologists (RCOG). Facts Views Vis Obgyn. 2019;11(1):5-25.
39. Coccolini F, Improta M, Sartelli M, Rasa K, Sawyer R, Coimbra R, et al. Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines. World Journal of Emergency Surgery. 2021;16(1):40.
40. Fico V, Altieri G, Di Grezia M, Bianchi V, Chiarello MM, Pepe G, et al. Surgical complications of oncological treatments: A narrative review. World J Gastrointest Surg. 2023;15(6):1056-67.
41. Levy JH, Shaw JR, Castellucci LA, Connors JM, Douketis J, Lindhoff-Last E, et al. Reversal of direct oral anticoagulants: guidance from the SSC of the ISTH. J Thromb Haemost. 2024;22(10):2889-99.
42. Thompson A, Fleischmann KE, Smilowitz NR, de Las Fuentes L, Mukherjee D, Aggarwal NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;150(19):e351-e442.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 International Journal of Medical Science
This work is licensed under a Creative Commons Attribution 4.0 International License.
