From the Guidelines
Abdominal guarding is a clinical sign that indicates the presence of peritonitis, suggesting an underlying intra-abdominal pathology that requires prompt medical attention. This protective mechanism occurs when the parietal peritoneum becomes irritated, causing reflexive muscle contraction to minimize movement and reduce pain, as discussed in the 2017 WSES guidelines for management of intra-abdominal infections 1. Guarding can be voluntary, where a patient tenses muscles due to anticipated pain, or involuntary (true guarding), which is more clinically significant. Involuntary guarding is often accompanied by other signs of peritonitis such as rebound tenderness, rigidity, and pain with movement.
The diagnosis of intra-abdominal infections, including those causing abdominal guarding, is based primarily on clinical assessment, including symptoms like abdominal pain, fever, tachycardia, and tachypnoea, as well as signs such as abdominal rigidity and hypoperfusion signs like lactic acidosis, oliguria, and acute alteration of mental status 1. Common causes of abdominal guarding include appendicitis, cholecystitis, perforated ulcer, diverticulitis, or intra-abdominal abscess. The location of guarding can help localize the problem—right upper quadrant guarding may suggest gallbladder disease, while right lower quadrant guarding often indicates appendicitis.
When guarding is detected during examination, further diagnostic workup including laboratory tests and imaging studies is typically warranted to identify the underlying cause and determine appropriate treatment. In emergency departments of limited-resource hospitals, the diagnosis of intra-abdominal infections is mainly clinical, supported by basic laboratory tests like full blood count, and ultrasonography if available 1. However, in high-income countries, CT has become the gold standard for diagnosis, especially when the diagnosis is uncertain, due to its higher sensitivity and resolution compared to ultrasound 1.
From the Research
Abdominal Guarding Indication
Abdominal guarding is a clinical sign that indicates abdominal tenderness and muscle tension. The evidence suggests that abdominal guarding is associated with various abdominal conditions, including:
Clinical Significance
Abdominal guarding is a significant clinical sign that requires further evaluation to determine the underlying cause. The presence of abdominal guarding, along with other symptoms such as abdominal pain, distension, and foul-smelling drainage, can indicate a serious condition that requires prompt medical attention 2, 6.
Diagnostic Approaches
The diagnosis of abdominal conditions associated with abdominal guarding can be made using various imaging modalities, including:
These diagnostic approaches can help identify the underlying cause of abdominal guarding and guide treatment decisions.