Diagnostic Considerations

Important considerations

In elderly patients with abdominal pain, do not rely on descriptions of the "classic presentation" for diseases in the diagnosis of acute abdomen, and do not rely on the presence of fever or leukocytosis as a sign of infection.

Ensure the patient to be admitted is admitted to the appropriate service.

Diagnosing gastroenteritis or constipation

Perform a rectal examination in patients with abdominal pain (not performing a rectal examination may be associated with increased rate of misdiagnosis)

Other conditions to be considered

Other conditions to consider in elderly patients with abdominal pain include the following:

Malignancy
Ogilvie syndrome
Volvulus (see Large-Bowel Obstruction)

Differential Diagnoses

Appendicitis
Bacterial Pneumonia
Cholecystitis and Biliary Colic
Constipation
Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females
Diabetic Ketoacidosis (DKA)
Diverticulitis
Emergent Management of Pancreatitis
Emergent Treatment of Gastroenteritis
Hernias
Herpes Zoster
Inflammatory Bowel Disease
Large-Bowel Obstruction
Mesenteric Ischemia Imaging
Myocardial Infarction
Nephrolithiasis
Peptic Ulcer Disease
Small-Bowel Obstruction
Spontaneous Bacterial Peritonitis (SBP)
Urinary Tract Obstruction Management in the ED
Urinary Tract Infection (UTI) in Males

Workup

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Media Gallery

Inflammatory mass in the right lower quadrant of an 84-year-old woman with mild abdominal pain of 2 days' duration. A ruptured appendix was found at surgery.
CT scan of a 76-year-old woman with severe abdominal pain of 3 hours' duration. Note the ringlike enhancement of bowel wall in the posterior abdomen. Ischemic small bowel was resected at surgery.
Radiograph of a 90-year-old man with abdominal pain of 4 days' duration. Plain films reveal large bowel dilatation. Sigmoid volvulus with ischemic colon was diagnosed at surgery.
Radiograph of a 79-year-old woman with several hours of diffuse abdominal pain. Initial examination of the plain films suggests bowel obstruction.
Radiograph of a 79-year-old woman with several hours of diffuse abdominal pain. Initial examination of the plain films suggests bowel obstruction. Close-up view reveals pneumatosis intestinalis, indicating mesenteric ischemia.
CT scan of a 64-year-old woman with vague abdominal pain of 2 days' duration. Physical examination revealed a tender palpable mass in the left lower quadrant. CT scan reveals an incarcerated ventral hernia.
CT scan of a 62-year-old man who reported 2 weeks of left lower quadrant abdominal pain. CT scan reveals fat stranding and multiple diverticula around the descending colon. A phlegmon containing bowel and inflammatory tissue has eroded into the left psoas muscle.
A lower CT scan slice from a 62-year-old man who reported 2 weeks of left lower quadrant abdominal pain. Multiple diverticula are observed with an inflammatory mass overlying the left ilium.