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Acute abdominal pain is frequent and often distressing. This symptom must start a clinical investigation with mostly questioning and abdominal palpation for correct diagnosis and decision making. Half of the patients have either appendicitis or non-specific abdominal pain.

Using a data base of 7,000 acute abdominal pains, we have described the assessed clinical features of acute diverticulitis of the sigmoid colon. Percentages of sensitivities have been replaced by adverbs or adjectives, applying a scale of equivalence. The modifications of the positive predictive values have been also replaced by verbs or typical expressions. In this article, abscesses, fistulas, generalized peritonitis and hemorrhage arising from an acute diverticulitis of the sigmoid colon were not studied.

Perforated diverticulitis is an uncommon but severe complication of diverticular disease. Whatever the type of the contamination, whether bacterial or fecal, the peritonitis is responsible for septic shock, which necessitates emergent and aggressive medical and surgical treatment. Intensive intravenous perfusion under monitoring, adapted antibiotherapy should come before surgical decision. The aim of surgery is twofold: to suppress the infectious source and to clean the peritoneum. After all, the peritonitis has a tendency to recur and therefore postoperative abscesses have to be searched systematically and if the case arises, these abscesses have to be reoperated or drained. Best results were obtained with immediate sigmoidectomy and colo-rectal anastomosis associated with loop colostomy; that procedure should be preferred to Hartmann technique. If the morbidity remains high, the mortality should decrease under 10% with intensive therapy.

The prevalence of signs and symptoms of acute intestinal obstruction in the adult was studied in a prospective study of 600 cases extracted from a data base on acute abdomen in 7,000 patients. This study of prevalence allows a precise definition of intestinal obstruction syndrome and to differentiate two types of presentations according to the site of obstruction on the small bowel or the colon. However, it is more difficult to differentiate simple bowel obturation from vascular strangulation. Surgical treatment depends mainly on the cause of obstruction.

Incarcerated hernia or wound dehiscence are responsible for more than 10% of small bowel obstructions. The complication is easily recognized when hernia or wound dehiscence was previously diagnosed. Difficulties occur when mass is deeply located in a thick abdominal wall or inside the inguinal canal. Femoral hernias and direct inguinal hernias are those which strangulate the most. Strangulation in wound dehiscence is the most severe. Strangulated hernia should be routinely excluded in patient with intestinal obstruction, to avoid inappropriate surgical approach.

Using a data base of 7,000 acute abdominal pains, we here described the assessed clinical manifestations of the main diseases responsible for right lower quadrant pain. However, percentages of sensibilities have been replaced by adverbs or adjectives, applying a scale of equivalence. The possible modifications of the positive predictive values have been also replaced by verbs or typical expressions. We first described the acute appendicitis syndrome (which covered congestive endoappendicitis and suppurated appendicitis) with the clinical shades or the gathered and gangrenous forms or even of the diffuse peritonitis. Features of the acute appendicitis contrast with those of the so called "non specified abdominal pains" (a new entity), and those of the subacute or chronic appendicitis. We found a good correlation between clinical and pathological findings. One of the difficulties has been to determine if a subgroup of subacute appendicitis should be or not included into the acute appendicitis.

Each year in France, 75,000 appendectomies are carried out for normal or fibrous appendix and another 75,000 for a mere inflammation of the mucosa of submucosa. To decrease the incidence--four times higher than in other countries--it is suggested to keep under observation the patient with RIQ tenderness if they have neither rebound nor guarding, a temperature below or equal to 38 degrees C and a white blood cell count lower than 10,000/mm3. By following these guidelines, there is no risk to miss perforated or suppurated appendicitis.

A computer aid diagnosis of acute abdominal pain has been constructed on a 7,000 cases data base, using a Bayesian model. The system is used as a paraclinic test, increasing the reliability of the physician's clinical diagnosis or questioning that diagnosis in case of discrepancy.