8 Acute abdomen
The term acute abdomen refers to a syndrome that involves the acute onset of clinical signs secondary to an intra-abdominal disorder which typically has the potential to be fatal. In a significant proportion of these cases, abdominal pain is a strong feature but may be harder to detect in cats. There are a large number of potential causes of acute abdomen, many of which require emergency surgical intervention following stabilization of major body system abnormalities. An important part of the early management of a patient with acute abdomen is to determine whether emergency surgical intervention is required. Some of the more common causes of acute abdomen are listed in Box 8.1.
Acute abdomen can be mistaken for a small number of other conditions, most notably painful spinal disorders and hypoadrenocorticism (Addison’s disease).
In some animals, especially smaller ones, it can be difficult to differentiate abdominal pain from spinal (especially thoracolumbar) pain and the author is aware of animals with spinal disease that have undergone negative exploratory laparotomy following misdiagnosis.
Signalment, history, physical examination and diagnostic findings are often helpful in differentiating acute abdomen from spinal disease. In particular, animals with uncomplicated spinal disease are unlikely to show marked cardiovascular compromise that is a common feature of acute abdomen. Likewise animals with acute abdomen may be collapsed or weak but they are unlikely to show localized neurological signs.
Hypoadrenocorticism can be hard to differentiate from acute abdomen. Animals suffering from an acute Addisonian crisis may have a history of gastrointestinal signs, which is a common feature of acute abdomen. An acute Addisonian crisis almost by definition involves potentially marked cardiovascular compromise, and abdominal pain may also be a feature of this disease. Signalment, history and astute diagnostic investigations may be helpful here.