What are the criteria for urgent referral to secondary care for a patient with suspected acute abdomen?

For a patient with suspected acute abdomen, urgent referral to secondary care is indicated in several scenarios, often requiring immediate or same-day assessment.

• Immediate/Emergency Admission:
  • Arrange emergency admission for people who are systemically unwell with a suspected complication of gallstone disease, such as acute cholecystitis, cholangitis, or pancreatitis ².
  • Arrange emergency hospital admission if inflammatory bowel disease (IBD) is suspected and the person is systemically unwell with symptoms of bloody diarrhoea, fever, tachycardia, or hypotension ¹.
  • Refer to hospital as an emergency if pain related to gallstones cannot be managed in primary care ².
  • For suspected complicated acute diverticulitis, arrange same-day hospital assessment if the person has uncontrolled abdominal pain and any of the following: an abdominal mass or peri-rectal fullness, abdominal rigidity and guarding, signs of sepsis (altered mental state, raised respiratory rate, low systolic blood pressure, raised heart rate, low tympanic temperature, no urine output, or skin discolouration), or signs of intestinal obstruction (colicky abdominal pain, absolute constipation, vomiting, or abdominal distention) ⁶.
• Urgent Referral (e.g., within 2 weeks or urgent specialist review):
  • Suspected Cancer Pathways:
    • Refer adults using a suspected cancer pathway (for an appointment within 2 weeks) for colorectal cancer if they are aged 40 years and over with unexplained weight loss and abdominal pain, or 50 years and over with unexplained rectal bleeding, or 60 years and over with iron-deficiency anaemia, changes in bowel habit, or tests show faecal occult blood ¹.
    • Consider a suspected cancer pathway referral for colorectal cancer in all adults with a rectal or abdominal mass, or adults aged under 50 years with rectal bleeding and any of abdominal pain, change in bowel habit, weight loss, and/or iron-deficiency anaemia ¹.
    • Refer women aged 18 and over using a suspected cancer pathway referral if an abdominal or pelvic mass is identified by physical examination (which is not obviously uterine fibroids) ⁴.
    • Consider a suspected cancer pathway referral for an upper abdominal mass consistent with stomach cancer ⁴.
    • Refer people aged 55 years and over with upper abdominal pain and weight loss using a suspected cancer pathway referral for oesophageal or stomach cancer ⁴.
    • Refer people aged 40 years and over with jaundice using a suspected cancer pathway referral for pancreatic cancer ⁵.
  • Other Urgent Conditions:
    • Refer urgently (to gastroenterology or a surgical service with expertise in managing biliary diseases) people with known gallstones and jaundice, or if there is a clinical suspicion of biliary obstruction (for example, significantly abnormal liver function tests) ².
    • If inflammatory bowel disease (IBD) is suspected but hospital admission is not indicated, arrange an urgent referral to a gastroenterologist for confirmation of diagnosis and initiation of specialist drug treatments ¹.
    • Consider an urgent direct access ultrasound scan (to be done within 2 weeks) for an upper abdominal mass consistent with an enlarged gall bladder or an enlarged liver ⁴.
    • Consider an urgent direct access CT scan (to be performed within 2 weeks), or an urgent ultrasound scan if CT is not available, to assess for pancreatic cancer in people aged 60 years and over with weight loss and any of diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation, or new-onset diabetes ⁵.
    • Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for oesophageal or stomach cancer in people with dysphagia, or those aged 55 years and over with weight loss and any of upper abdominal pain, reflux, or dyspepsia ⁵.
    • For people with suspected uncomplicated acute diverticulitis who are not referred for same-day hospital assessment, if their symptoms persist or worsen, consider referral to secondary care for further assessment ⁶.