Abdominal crisis in sickle cell anaemia

These crises are characterised by severe abdominal pain with the signs of an acute abdomen; they are probably due to sequestration of sickled cells in the circulation of the gut.

Some common conditions seen frequently as acute abdominal pain in SCD includes:

• vaso-occlusion – in the mesenteric circulation
• cholelithiasis
• cholangitis
• mesenteric/colonic ischaemia
• hepatic infarction/abscess/sequestration
• intra-abdominal abscess
• splenic infarction
• renal or hepatic vein thrombosis (1)

Management of acute abdomen

• appropriate examinations should be carried out in patients who presents with an acute abdomen e.g. - blood cultures, serum amylase, abdominal ultrasound, abdominal X-ray and CT
• acute abdominal pain due to SCD is managed conservatively in most cases,
• early involvement of the surgical team should be considered
• laparascopic cholecystectomy is recommended for treatment of symptomatic gallstones (1).

Reference:

• (1) Sickle Cell Society 2008. Standards for the clinical care of adults with sickle cell disease in the UK