Acute Abdominal Pain in Young Adults

Etiologies and Diagnostic Approach

The American Academy of Pediatrics recommends considering torsion ovarienne intermittente as a cause of acute abdominal pain in young women, which may resolve spontaneously, causing severe pain that stops abruptly when the ovary returns to its normal position 1, 2
The American College of Radiology suggests that appendicitis can resolve spontaneously without perforation in some cases, particularly if the appendiceal obstruction is relieved 4, 5
The American College of Radiology also recommends considering adénite mésentérique as a cause of abdominal pain that mimics appendicitis but resolves spontaneously 2, 4
The American Urological Association notes that colique néphrétique avec passage spontané de calcul can cause severe colic pain that stops abruptly when the stone passes, with stones <5 mm passing spontaneously in 90% of cases 3

The American College of Radiology recommends documenting the characteristics of the pain, including location, radiation, and relation to position, to help guide the diagnostic evaluation 5, 3
The American College of Radiology suggests that an ultrasound is the initial imaging exam of choice for young women with lower abdominal pain, as it can identify ovarian pathology, cysts, and appendicitis without radiation 5, 2
The American College of Radiology also recommends a CT scan with IV contrast if the ultrasound is non-diagnostic and clinical suspicion is high, with a sensitivity of 95% and specificity of 94% for appendicitis 5

The American College of Emergency Physicians recommends immediate admission for patients with signs of peritonitis, instability, or fever with persistent pain, as well as those with a suspected ovarian torsion or ectopic pregnancy 4, 6
The American Academy of Family Physicians suggests rapid outpatient follow-up (24-48 hours) for patients with resolved pain but uncertain diagnosis, possible appendicitis with intermediate clinical score, or small kidney stones (<5 mm) identified 3, 4, 5
The American College of Emergency Physicians recommends urgent re-evaluation if there is a recurrence of pain within 72 hours, or if the patient develops fever, persistent vomiting, or inability to urinate 4, 3