Time-Critical Surgical Acute Abdomen: A Narrative Review of Diagnostic Pathways, Escalation Processes, and Multidisciplinary Care

Introduction: Acute abdominal pathology remains a common and diagnostically challenging emergency presentation. A clinically important subset requires urgent surgical or interventional management, and delays may lead to bowel necrosis, sepsis, shock, multi-organ failure, and death. Methods: A structured search of PubMed/MEDLINE, PubMed Central, Scopus, and Google Scholar was performed. International guidelines, systematic reviews, meta-analyses, and clinically relevant observational studies were prioritised, with a focus on obstruction, ischaemia, perforation, intra-abdominal infection, biliary emergencies, haemorrhage, and trauma-related abdominal pathology. Results: The reviewed evidence shows that the surgical acute abdomen is mainly driven by obstruction, ischaemia, perforation/infection, and haemorrhage. Early diagnosis remains difficult because symptoms may be non-specific and presentations atypical, especially in older or comorbid patients. Repeated reassessment, risk-based imaging, early recognition of red-flag features, and timely surgical consultation are consistently associated with improved outcomes. Conclusions: Effective management of the acute abdomen requiring surgical intervention depends on early recognition of time-critical pathology, structured diagnostic pathways, and prompt source control. Further research should focus on standardised care pathways that reduce time-to-intervention while maintaining patient safety.