Definition
Chronic abdominal pain is usually used to refer to pain that is either long-standing, of prolonged duration or of recurrent/intermittent nature. Chronic pain may be associated with acute exacerbations.
- Chronic abdominal pain of prolonged duration requires investigation.
- Adhesions as a cause of chronic abdominal pain should be a diagnosis of exclusion.
- IBS is less common than supposed – any atypical bowel symptoms should be investigated fully before diagnosing IBS.
- Back pain suggests a retroperitoneal origin (e.g. pancreas, duodenum, upper urinary tract, aorta).
- Sacral pain suggests a pelvic origin.
- Relationship to food strongly suggests a physical pathology and always requires investigation.
Important Diagnostic Features
Irritable Bowel Syndrome
- Syndrome of colicky abdominal pain, bloating, hard pellety or watery stools, sensation of incomplete evacuation, often associated with frequency and urgency.
- Blood with stools, mucus, abdominal physical findings, weight loss, recent onset of symptoms or onset in old age should suggest an organic cause and require thorough investigation.
Adhesions
Associated with several syndromes of chronic or recurrent abdominal symptoms.
Adhesional Abdominal Pain
Difficult to diagnose with any confidence, usually a diagnosis of exclusion, may be suggested by small bowel enema showing evidence of delayed transit or fixed strictures, uncertain response to surgical (laparoscopic) adhesiolysis.
Recurrent Incomplete Small Bowel Obstruction
Transient episodes of obstructive symptoms, often do not have all classic signs or symptoms present, abdominal signs may be unremarkable, self-limiting. Obstruction due to adhesions often settles with conservative treatment (IV fluids, NPO, NG tube). Non-resolution or development of physical signs (e.g. abdominal tenderness) are indications for laparotomy/laparoscopy. Best investigation – contrast follow through.
Mesenteric Angina
Classically occurs shortly after eating in elderly patients, colicky central abdominal pain, vomiting, food fear and weight loss. Usually associated with other occlusive vascular disease. Difficult to diagnose. Best investigation – CT angiography.
Meckel’s Diverticulum
May cause undiagnosed central abdominal pain in young adults. Occasionally associated with obscure PR bleeding, anaemia. Best investigation – radionuclide scanning (technetium-99m-pertechnate).
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