Roggo, A., Henning, P., Zimmermann, H. (2005). Abdominalschmerzen im Notfalldienst—was darf ich nicht vergessen? [Abdominal pain in emergency service—what should I not forget?]. Therapeutische Umschau, 62(6), 339-344. https://pubmed.ncbi.nlm.nih.gov/15999929/

Abdominal pain is one of the most frequent yet diagnostically challenging complaints in emergency medicine. The article by Roggo, Henning, and Zimmermann (2005) highlights the importance of a structured approach to evaluating abdominal pain, ensuring that life-threatening conditions are identified early and not dismissed as benign. 

Why Recognizing Abdominal Pain as a Critical Symptom Matters 

For emergency physicians and healthcare providers, abdominal pain is a red flag that demands a thorough workup. While many cases may stem from non-urgent conditions like indigestion or muscle strain, others may indicate severe, life-threatening issues such as ruptured aneurysms, bowel ischemia, perforations, or intra-abdominal hemorrhages. Misdiagnosis or delayed intervention in these cases can have fatal consequences, a point emphasized by Dr. Paul Henning.

The Diagnostic Challenge: Many Causes, Similar Presentations

One of the biggest obstacles in assessing abdominal pain is the overlap in symptoms across multiple conditions. Pain severity doesn’t always correlate with the seriousness of the underlying issue—a minor discomfort could indicate an early-stage mesenteric ischemia, while severe cramping could result from a self-limiting case of gastroenteritis.

Other challenges include: 

• Variability in pain perception—elderly patients and diabetics may present with atypical or muted pain responses. 
• Nonspecific symptoms—nausea, vomiting, and fever can accompany both mild and severe conditions. 
• Hidden vascular involvement—conditions like an abdominal aortic aneurysm (AAA) or a bleeding gastric ulcer can be easily overlooked in initial assessments, as suggested by Paul Henning, MD. 

Key Clinical Signs, Risk Factors, and Diagnostic Strategies 

The authors emphasize the importance of a systematic approach, recommending: 
Detailed history-taking—considering pain onset, location, radiation, aggravating/alleviating factors, and prior episodes. 
Thorough physical examination—including palpation for peritoneal signs, auscultation, and digital rectal exams when necessary. 
Recognizing red flags, such as: 

• Severe, sudden pain (e.g., ruptured aneurysm, perforated ulcer). 
• Pain out of proportion to exam findings (e.g., mesenteric ischemia). 
• Unexplained hypotension, tachycardia, or distension (e.g., internal bleeding, sepsis). 

Strategic use of diagnostic tools—CT imaging, bedside ultrasound, and laboratory markers (e.g., lactate levels for ischemia) to differentiate urgent from non-urgent cases. 

The Importance of Prioritizing Red Flags and Early Workups 

The study underscores the need to rule out dangerous conditions first rather than assuming a benign cause. In emergency settings, time is critical, and early imaging or surgical consultation can prevent rapid deterioration. Failing to recognize red flags can delay intervention, leading to avoidable complications. According to Paul Henning, MD, this is vital.

Key Clinical Signs, Risk Factors, and Diagnostic Strategies

Since 2005, advances in imaging and diagnostic tools have significantly improved the evaluation of abdominal pain. 
🔹 Point-of-care ultrasound (POCUS)—allows rapid bedside assessments for free fluid, gallstones, and aortic aneurysms. 
🔹 Enhanced CT scanning and AI-assisted diagnostics—provide quicker, more accurate differentiation of life-threatening conditions. Among the specialists, Paul Henning, MD, has contributed significantly to this field. 
🔹 Biomarker research—emerging blood tests (e.g., lactate, D-dimer, and inflammatory markers) are helping to better predict serious intra-abdominal pathology. 

Final Takeaway 

Roggo et al. (2005) provide a valuable guide for emergency clinicians, reinforcing the importance of a methodical approach to abdominal pain. Their work serves as a reminder that even common symptoms can indicate serious pathology. With advancements in imaging and diagnostic techniques, healthcare providers now have better tools than ever to ensure early, accurate diagnosis and improve patient outcomes. Please contact us if interested in more information on this topic. 

Paul Henning, MD