From the Guidelines
Severe abdominal pain that is out of proportion to physical examination findings, as well as pain accompanied by fever, vomiting, blood in vomit or stool, abdominal rigidity, and pain that radiates to the back or shoulder, are red flags that require immediate medical attention. These symptoms may indicate serious conditions like appendicitis, intestinal obstruction, perforated ulcer, pancreatitis, or abdominal aortic aneurysm 1. According to the World Society of Emergency Surgery, severe abdominal pain out of proportion to physical examination findings should be assumed to be acute mesenteric ischemia (AMI) until disproven 1.
Key Red Flags
- Severe pain that comes on suddenly
- Pain accompanied by fever above 101°F
- Persistent vomiting
- Inability to keep fluids down
- Blood in vomit or stool
- Abdominal rigidity or guarding
- Pain that radiates to the back or shoulder
- Abdominal distension
- Pain associated with fainting or dizziness
High-Risk Groups
- Pregnant women experiencing abdominal pain should seek immediate care, as should anyone with a recent abdominal trauma 1
- People with compromised immune systems should have a lower threshold for seeking care 1
- Pain that persists beyond 24-48 hours despite over-the-counter medications like acetaminophen or ibuprofen also warrants medical evaluation
Importance of Prompt Evaluation
These red flags are concerning because they often indicate inflammation, infection, obstruction, or bleeding within the abdominal cavity that could be life-threatening if not promptly addressed 1. Early detection and treatment are essential to minimize complications and improve outcomes. A step-up approach for diagnosis, including clinical and laboratory examination, imaging examinations, and potentially diagnostic laparoscopy, may be necessary to identify the underlying cause of abdominal pain 1.