Sudden-onset abdominal pain — reaching full intensity within minutes — is a potential surgical emergency. The most dangerous causes (ruptured aortic aneurysm, perforated viscus, mesenteric ischaemia) are life-threatening within hours.
The abdomen contains hollow organs (stomach, bowel, bladder), solid organs (liver, spleen, kidneys), and major vessels — all capable of causing catastrophic sudden pain. Location, radiation, character, and associated signs narrow the differential. Key rule: sudden severe abdominal pain in an adult over 50 is a vascular emergency until proven otherwise.
Appendicitis
Initially periumbilical, then migrates to right iliac fossa over 6–12 hours. Fever, anorexia, rebound tenderness. Most common surgical emergency.
Ruptured/leaking aortic aneurysm
Sudden severe central/back pain in patient over 60 — haemodynamic instability. Call emergency services — 90% mortality without surgery.
Perforated peptic ulcer
Sudden epigastric pain 'like a knife', board-rigid abdomen, lying still. Free air under diaphragm on X-ray.
Biliary colic / acute cholecystitis
Sudden right upper quadrant pain after fatty meal, radiating to right shoulder. Fever suggests cholecystitis.
Renal colic (ureteric stone)
Sudden, severe, colicky loin-to-groin pain with no comfortable position. Haematuria on urine dipstick.
Mesenteric ischaemia
Sudden severe periumbilical pain disproportionate to examination findings — high mortality. Risk factors: AF, atherosclerosis, clotting disorder.
Sudden right upper quadrant pain with urticaria or anaphylaxis — ruptured hydatid cyst. Rare but surgical emergency.
Signs of emergency: pain reaching 7–10/10 severity quickly; rigid or board-like abdomen; pain with fever >38.5°C; inability to move or find a comfortable position; vomiting blood or blood in stool; fainting or dizziness alongside pain; known abdominal aortic aneurysm. If any of these are present, call emergency services rather than driving to hospital.
Yes. A ruptured ovarian cyst causes sudden, sharp lower abdominal pain, often one-sided, and may be accompanied by nausea and dizziness. It can mimic appendicitis. A ruptured corpus luteum cyst can cause significant intra-abdominal bleeding — if pain is severe with dizziness or fainting, emergency assessment is needed. Pelvic ultrasound confirms the diagnosis.
Yes in specific scenarios. A ruptured hydatid cyst (echinococcosis) causes acute right upper quadrant pain with potential anaphylaxis — a surgical emergency. Heavy Ascaris infestations can cause sudden intestinal obstruction or biliary colic when adult worms migrate to the bile duct or appendix. Both are rare but require immediate surgery.
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