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Vascular Disturbances A frequent misconception, despite abundant experience to the contrary, is that pain associated with intraabdominal vascular disturbances is sudden and catastrophic in nature. The pain of embolism or thrombosis of the superior mesenteric artery or that of impending rupture of an abdominal aortic aneurysm certainly may be severe and diffuse. Yet, just as frequently, the patient with occlusion of the superior mesenteric artery has only mild continuous diffuse pain for 2 or 3 days before vascular collapse or findings of peritoneal inflammation appear. The early, seemingly insignificant discomfort is caused by hyperperistalsis rather than peritoneal inflammation. Indeed, absence. | Chapter 014. Abdominal Pain Part 3 Vascular Disturbances A frequent misconception despite abundant experience to the contrary is that pain associated with intraabdominal vascular disturbances is sudden and catastrophic in nature. The pain of embolism or thrombosis of the superior mesenteric artery or that of impending rupture of an abdominal aortic aneurysm certainly may be severe and diffuse. Yet just as frequently the patient with occlusion of the superior mesenteric artery has only mild continuous diffuse pain for 2 or 3 days before vascular collapse or findings of peritoneal inflammation appear. The early seemingly insignificant discomfort is caused by hyperperistalsis rather than peritoneal inflammation. Indeed absence of tenderness and rigidity in the presence of continuous diffuse pain in a patient likely to have vascular disease is quite characteristic of occlusion of the superior mesenteric artery. Abdominal pain with radiation to the sacral region flank or genitalia should always signal the possible presence of a rupturing abdominal aortic aneurysm. This pain may persist over a period of several days before rupture and collapse occur. Abdominal Wall Pain arising from the abdominal wall is usually constant and aching. Movement prolonged standing and pressure accentuate the discomfort and muscle spasm. In the case of hematoma of the rectus sheath now most frequently encountered in association with anticoagulant therapy a mass may be present in the lower quadrants of the abdomen. Simultaneous involvement of muscles in other parts of the body usually serves to differentiate myositis of the abdominal wall from an intraabdominal process that might cause pain in the same region. Referred Pain in Abdominal DiseasesPain referred to the abdomen from the thorax spine or genitalia may prove a vexing diagnostic problem because diseases of the upper part of the abdominal cavity such as acute cholecystitis or perforated ulcer are frequently associated with intrathoracic
