Non-specific abdominal pain

The number of elderly and frail patients admitted to the Emergency Department (ED) reporting non-specific abdominal pain (NSAP) is going to increase in the next decades. Acute abdomen remains a clinical challenge in the elderly patient. To distinguish which patients need surgery from non-surgical abdominal illnesses can be difficult. Less severe conditions can mimic major diagnoses requiring early intervention. Early diagnosis is essential in such patients, as delayed treatment can worsen overall clinical outcomes, especially in case of perforated peptic ulcer, acute cholecystitis and perforated diverticulitis. The use of computed tomography (CT) scan should be liberal, as the long-term side effect of radiation is of less concern in the elderly, compared to younger patients. Efforts to explain to the patient the range of therapeutic alternatives, risks and possible outcomes should precede final treatment decisions. Non-specific abdominal pain (NSAP) patients may be approached with different strategies, including clinical observation, laboratory tests, imaging (ultrasound (US) and/or CT scan), surgery (open or laparoscopic) or sent home early with planned outpatient follow-up. Even though relevant literature across the years has been published, it is not well established as to which approach guarantees the best outcome. Early laparoscopy maintains both a diagnostic and a therapeutic role, reduces hospital stay, improves morbidity and mortality, quality of life and it is cost-effective. Risk and benefits of this strategy have to be addressed individually.