Severe abdominal (stomach) pain is a debilitating pain preventing someone to continue with his/her daily activities. Abdominal cramps (spasms) are painful contractions of the hollow abdominal organs or muscles in abdominal wall lasting from few seconds to several hours. The cause of the pain or cramp can be usually suspected from its location and accompanying symptoms. Severe abdominal pain often requires urgent hospitalization but not always.

Severe Abdominal Pain Requiring Immediate Hospitalization

A person with:

  • Severe stomach pain, forcing him/her to sit or lie down
  • Pain, lasting over 10 minutes
  • Restlessness or unusual calmness
  • Pale face and lips
  • Shallow breathing and weak heart beat
  • Fever, chills, nausea or vomiting..

..should be admited to hospital immediately to treat a possible life threatening disorder, like:

1. Acute Appendicitis

Sudden right lower abdominal pain, which usually starts near the navel and gradually moves few inches toward left and down, tenderness at this spot, nausea, vomiting and fever are main symptoms of acute appendicitis, which can affect a person of any age. Inflamed appendix has to be surgically removed as soon as possible to prevent its perforation and life threatening abdominal inflammation.

Diagnosis in typical cases can be made from history and physical examination; in non-typical cases a CT is the main investigation. Appendix is removed through an inch wide incision in the abdominal wall. Prognosis is excellent; death from appendicitis is rare.

2. Acute Poisoning

Severe upper middle abdominal pain and cramps, vomiting and altered consciousness are main symptoms of acute poisoning due to ingesting of corrosive liquids (e.g. petrol, acids), excessive amount of medications or illegal drugs, inhaling of poisonous gases like war gases or pesticides.

Inducing vomiting with fingers pushed into the throat or drinking a glass of salted water may be tried only in conscious person but not if corrosive substances like petrol or acids were ingested. Stomach pumping, injecting antidots, hemodialysis, and intravenous fluid infusion are some of possible treatments measures.

More about chemical poisoning.

3. Infections

In the western world, food poisoning by bacteria or parasites in a previously healthy person is rarely serious despite possible dramatic vomiting, abdominal cramps and diarrhea. Food poisoning often heals on its own in few days, and if not, a doctor may prescribe oral antibiotics.

Rotavirus infection causing stomach flu with fever, stomach cramps, vomiting and diarrhea is also usually not a serious disease in the western world, but it is still a major cause of children deaths in Africa, South Asia and South America. Therapy is with replacing lost fluids by oral rehydration solutions or intravenous infusion.

4. Injuries with Internal Abdominal Bleeding

A hit to the stomach (often in car accidents), shot and knife injuries may cause bleeding into abdominal cavity. Abdominal pain, paleness, thirst and feeling of coolness are main symptoms.

Therapy. An urgent surgery is required.

5. Perforation of the Stomach or Intestine

Perforation of the stomach is a complication of advanced stomach ulcer or cancer. Perforation of the small intestine is rare. Perforation of the colon may occur in advanced Crohn’sor ulcerative colitis, diverticulitis, Clostridium difficile infection, colorectal cancer and during colonoscopy or surgery.

Therapy is with an urgent surgery.

6. Dissection or Rupture of Abdominal Aorta

In persons after 50 with advanced atherosclerosis, layers in the wall of abdominal part of the aorta may be split what may cause a sudden severe abdominal pain. Therapy is with an urgent surgery; many patients die before treatment starts, though.


Article reviewed by Dr. Greg. Last updated on December 17, 2011