Acute abdominal pain in non-pregnant women presenting to the University Teaching Hospital in Rwanda

Acute abdominal pain in non-pregnant women presenting to the University Teaching Hospital in Rwanda | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Acute abdominal pain in non-pregnant women presenting to the University Teaching Hospital in Rwanda TURAMYIMANA Faustin, DUSHIME Jean Paul, MANIRAFASHA Appolinaire, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7706524/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Acute non-traumatic abdominal pain in non-pregnant women is common in emergency units. Determining its etiology can be challenging, particularly in childbearing age, and requires prompt management. However, women’s abdominal pain has not been studied separately in Rwanda or in the region. Objective To describe the clinical profile, etiologies, management, and outcomes of non-pregnant women presenting with acute non-traumatic abdominal pain at the Rwanda tertiary hospital. Methodology Secondary analysis of a prospective cohort at the University Teaching Hospital of Kigali (October 2023 - February 2024). Descriptive statistics, summarized presentation, and etiologies; logistic regression identified predictors for in-hospital mortality. Results We included 111 women (mean age of 38.3 ± 18.1 years; median age 34). At triage, 37.8% were unstable (Orange 33.3%, Red 4.5%). Pain was most often diffuse (53.2%), epigastric (17.1%), hypogastric (10.8%), or right upper quadrant (9.9%). Surgical diagnosis accounted for 46.8% of cases; 27.9%-received interventions, including 26.1% undergoing abdominal surgery. Leading etiologies were intestinal obstruction (20.7%, largely due to adhesions), non-specific abdominal pain (17.1%), peptic ulcer disease (11.7%, gastroenteritis (9.0%), biliary disease or liver abscess (9.0%, peritonitis (8.1%) and malignancy (6.3%). Gynecological causes contributed 8.1% (Adnexal masses 4.5%, Tubo-ovarian abscess 2.7%, and ruptured ectopic pregnancy at 0.9%). Mortality was 8.1% (9/111). Predictors of death included age ≥ 75 years (OR 7.0; p = 0.041, CI: 1.087–45.1), objectified abdominal distension (OR 17.5; p = 0.008, CI: 2.1—145.87), malignancy (OR 16.96; p < 0.001, CI: 3.701–77.76), and acute liver injury (OR 6.79; p = 0.018 CI: 1.392–33.09). Conclusion Non-pregnant women with acute abdominal pain frequently present unstable conditions, with nearly half having surgical diagnoses and substantial mortality. Non-specific abdominal pain warrants gynecological assessment and, where available, laparoscopy to avoid missed diagnosis. Broader differential diagnosis, especially in older patients and those with abdominal distension, malignancy, liver injury, and timely surgical or oncological management, may improve outcomes. Strengthening early identification and treatment of high-risk conditions is essential to reducing mortality in this population. acute abdominal pain women’s abdominal pain non-traumatic abdominal pain clinical outcomes Emergency triage African Relevance Women’s abdominal pain is understudied in Rwanda and wider Africa. Limited diagnostic resources delay recognition of gynecological emergencies. Post-surgical adhesions remain a leading preventable cause regionally. Emergency triage strengthening reduces preventable deaths in African hospitals. Findings inform regional policies on women’s emergency and surgical care. Introduction Acute non-traumatic abdominal pain is of particular concern in emergency medicine, as it is a frequent and complex presenting complaint with a broad differential diagnosis. ( 1 , 2 ) In non-pregnant women, this diagnostic challenge requires careful distinction between gastrointestinal, urological, gynecological, and obstetric etiologies. ( 3 ) Gynecological conditions often predominate and include primary dysmenorrhea, endometriosis, mittelschmerz, pelvic inflammatory disease, ovarian cyst accidents, and adhesions. ( 4 ) In Rwanda, acute abdominal pain represents 10.4% of all emergency department (ED) consultations. Although general data are available, the specific etiologies, management approaches, and outcomes for non-pregnant female patients with abdominal pain have not been well characterized in this context. This secondary analysis of a prospective study aims to describe the clinical profile, management, and outcomes of non-pregnant female patients presenting with acute abdominal pain to the ED of a Rwandan tertiary teaching hospital. . Materials and methods Design and Research Setting The study is a secondary data analysis of a prospective cohort study conducted at the Emergency Department of the University Teaching Hospital of Kigali (CHUK), the largest tertiary hospital in Rwanda. The original cohort, published by Turamyimana et al. in the African Journal of Emergency Medicine, included patients aged 16years or older presenting with acute non-traumatic abdominal pain between October 1, 2023, and February 29, 2024. ( 5 ) For this analysis, we excluded male patients and focused exclusively on female patients. Study procedure The original dataset prospectively recorded demographic information, clinical features, investigations, management approaches, complications, and outcomes. For this secondary analysis, data were extracted for females (all presented knowing they are not pregnant) patients. The primary outcome was in-hospital mortality, while secondary outcomes included predictors of death. Data analysis Data were analyzed using the Jamovi platform version 2.7.6.0 ( https://www.jamovi.org/ ). Descriptive statistics were used to summarize baseline characteristics, clinical features, etiologies, management, and outcomes. Binomial logistic regression was used to assess predictors of mortality. A p-value < 0.05 was considered statistically significant. Ethical Consideration This secondary analysis used data from a prospective cohort study conducted at the Emergency Department of the University Teaching Hospital of Kigali (CHUK) between October 1, 2023, and February 29, 2024. The original study was approved by the Institutional Review Board of the College of Medicine and Health Sciences, University of Rwanda (Approval No. 370/CMHS IRB/2023), and by the Ethics Committee of CHUK (Approval Ref. EC/CHUK/159/2023). Both committees reviewed and approved the informed consent process. Written informed consent was obtained from all participants, covering study purpose, voluntary participation, confidentiality, and the right to withdraw without affecting their care. This secondary analysis was conducted under the same approvals. Result With 261 patients included in the original study, 111 patients were females. The mean age for female patients was 38.3 (± 18.1 standard deviation). Among non-pregnant women presenting with acute abdominal pain (N = 111), 37.8% (N = 42) were classified as unstable (orange or red triage). Pain was most often diffuse 53.2% (N = 59), followed by epigastric 17.1% (N = 19) and hypogastric 10.8% (N = 12). The most frequent associated symptoms were non-bilious vomiting 38% (N = 42), abdominal distension 35% (N = 39), constipation 32.4% (N = 36), gas arrest 27.9% (N = 31), and fever 20.7% (N = 23). Relevant past medical history included hypertension 5.4% (N = 6), peptic ulcer disease 5.4% (N = 6), diabetes 2.7% (N = 3), and retroviral disease 3.6% (N = 4), while 7.2% (N = 8) had prior abdominal surgery. On clinical examination, diffuse abdominal tenderness was noted in 36.9% (N = 41), abdominal distension in 36% (N = 40), and epigastric tenderness in 31.5% (N = 35), with rebound tenderness in 10.8% (N = 12). The leading etiologies were intestinal obstruction 20.7% (N = 23), non-specific abdominal pain 17.1% (N = 19), peptic ulcer disease 11.7% (N = 13), biliary colic/cholecystitis/liver abscess 9% (N = 10), gastroenteritis 9% (N = 10), peritonitis 8.1% (N = 9), and malignancy 6% (N = 7). Less frequent causes (≤ 5%) included adnexal masses 4.5% (N = 5), tubo-ovarian abscesses 2.7% (N = 3), and intra-abdominal abscesses 2.7% (N = 3). A full detailed table of triage categories, locations, symptoms, past history, clinical findings, and etiologies is provided as Supplementary Table 1. Nearly half of the non-pregnant women with abdominal pain (46.8%, N = 52) were managed by the surgical team (Table 1). Interventional management was required in 27.9% of patients, including 26.1% (n = 29) who underwent abdominal surgery, one who had a colonoscopy, and one who had cystoscopy with bilateral stent placement. Gynecological causes accounted for 8.1% of cases, including adnexal masses (4.5%), tubo-ovarian abscesses (2.7%), and 1 case of ruptured ectopic pregnancy (0.9%). Overall, 18% (n = 20) were managed conservatively. Most non-surgical cases were treated as outpatients (30.6%, n = 34), while 19.8% (n = 22) required admission to internal medicine. A small group (n = 5) was managed in the Emergency Department and discharged home, including two cases of intestinal obstruction treated conservatively and three medical cases. Table 1. Baseline characteristics and clinical features of non-pregnant women with acute abdominal pain Triage categories by locally modified South Africa Triage Scale N % Orange 37 33.3% Red 5 4.5% Unstable patient(orange and red) 42 37.8% Location of symptoms Diffuse abdominal pain 59 53.2% Epigastric pain 19 17.1% Hypogastric pain 12 10.8% Right upper quadrant pain 11 9.9% Periumbilical pain 7 6.3% Other locations 3 2.7% Associated symptoms Non-bilious vomiting 42 37.8% Abdominal distension 39 35.1% Constipation 36 32.4% Gas arrest 31 27.9% Fever 23 20.7% Headache 11 9.9% Bilious vomiting 9 8.1% Weight loss 7 6.3% Jaundice 7 6.3% Dysuria 7 6.3% Cough 7 6.3% Altered mental status 3 2.3% Social history Alcohol 4 3.6% Herbal Medicine 3 2.7% Smoking 2 1.8% Past medical history Hypertension 6 5.4% Diabetes 3 2.7% Peptic Ulcer Disease 6 5.4% Retroviral disease 4 3.6% Hepatitis 1 0.09% Surgical history Abdominal surgery 8 7.2% Clinical findings Abdominal distension 40 36% Diffuse abdominal tenderness 41 36.9% Epigastric tenderness 35 31.5% Hypogastric tenderness 18 16.2% Right upper quadrant tenderness 20 18% Right lower quadrant 9 9.1% Left upper quadrant 4 3.6% Left lower quadrant 8 7.3% Periumbilical tenderness 9 8.1% Right frank tenderness 5 4.5% Left frank tenderness 3 2.7% Rebound tenderness 12 10.8% Guarding 3 2.7% Main etiology Intestinal obstruction 23 20.7% Non- specific abdominal pain 19 17.1% Peptic ulcer diseases 13 11.7% Biliary colic/cholecystitis/liver abscess 10 9.% Gastroenteritis 10 9.% Peritonitis 9 8.1% Malignancy 7 6.3% Adnexal masses 5 4.5% Urinary tract infection 4 3.6% Intra-abdominal abscesses 3 2.7% Tubo-ovarian abscess 3 2.7% Ureteric colic 2 1.8% Ruptured ectopic pregnancy 1 0.9% Pancreatitis 1 0.9% Dolichocolon 1 0.9% Outcome measures Among the 111 patients, nine died, giving a mortality rate of 8.1%. Factors significantly associated with death are summarized in Table 2 . Age ≥ 75 years (OR 7.0; 95% CI 1.09–45.1; p = 0.041), abdominal distension (OR 17.5; 95% CI 2.10–145.9; p = 0.008), malignancy (OR 16.96; 95% CI 3.70–77.8; p < 0.001), and acute liver injury (OR 6.79; 95% CI 1.39–33.1; p = 0.018) were independently associated with mortality. Table 2 Risk factors for in-hospital mortality Risk factor Odd ratio 95% Confidence interval p-value Age ≥75 years 7.0 1.087–45.1 0.041 Distended abdomen 17.5 2.10– 145.87 0.008 Malignancy 16.96 3.701–77.76 < 0.001 Acute liver injury 6.79 1.392–33.09 0.018 Discussion Abdominal pain in women is a common presentation among women in the emergency department, with etiologies including both gynecological and non-gynecological conditions( 3 , 6 ). In our study, non-gynecological predominated, with intestinal obstruction and other gastrointestinal disorders accounting for 60.3% of cases. This contrasts with the findings of Gilling Smith et al, where gynecological conditions were more frequent( 3 ). There are similar findings to our study by Hagipoglu et al., where gastrointestinal conditions were predominate cause in two-third of cases. ( 6 ) Nonspecific abdominal pain was less common in other studies; however, it may mask an underlying specific diagnosis, as noted by Gaitan et al. ( 7 ) Mortality in our study cohort was high but comparable to the regional rate, such as in Tanzania( 8 ), but mostly related to high age, distended abdomen, malignancy, and acute liver injury. This mortality is higher than that found in Germany, of 2.6% exclusive for female patients. ( 9 ) These findings provide insight into the burden and outcomes of acute abdominal pain among non-pregnant women in Rwanda. Limitations of the study This secondary analysis is subject to several limitations. First, selection bias is possible since the most severely ill patients were often unable to provide consent; inclusion of such patients might have led to even higher mortality estimates. Second, as a single-center study from a tertiary-care teaching hospital, the findings may not be generalizable to rural or lower-level facilities. Third, the analysis was restricted to variables collected in the original study, meaning that comorbidities, socioeconomic status, and healthcare-seeking behavior could not be assessed. Subgroup analyses further reduced the sample size, limiting statistical power. Finally, we did not follow patients after ED discharge, so outcomes such as repeat visits, complications, or deaths in the community were not captured. Despite these limitations, the prospective cohort design, standardized triage, and focus on a previously understudied group of non-pregnant women with acute abdominal pain strengthen the validity and relevance of our findings. Conclusion Abdominal pain complaints in women are a common presentation in Rwandan emergency departments, with nearly half of the patients having had surgical conditions. Only about a quarter required interventional management (27.9%), most of whom underwent abdominal surgery (26.1%). While non-gynecological causes predominated, gynecological conditions still represented a meaningful proportion and should not be overlooked. Patients with non-specific abdominal pain warrant careful evaluation with gynecological consultation or laparoscopic assessment to uncover otherwise missed pathology. Women of reproductive age should always be screened for pregnancy and investigated for tubo-ovarian or adnexal pathology. The predominance of intestinal obstruction, largely due to post-surgical adhesions, underscores the need for preventive strategies and vigilant postoperative follow-up. Early recognition and prioritization of high-risk patients, particularly older women and those presenting with abdominal distension, malignancy, or acute liver injury, may enable more timely surgical and oncologic interventions and help reduce mortality in resource-limited settings. Although these findings come from a single tertiary center and should be interpreted with caution, given potential selection bias and absence of post-discharge follow-up, the prospective, systematically collected dataset from the country’s largest referral hospital strengthens the validity and regional relevance of the results. Dissemination of results We will share the results of this secondary analysis mainly through academic and professional channels. The findings will appear in peer-reviewed journals and be presented at scientific conferences, both internationally and regionally, to help expand knowledge about abdominal pain in emergency departments. Locally, we will communicate the results to CHUK leadership, the Ministry of Health, and clinical teams to support policy and practice improvements. We will also use the findings in academic discussions and training programs to strengthen emergency care in Rwanda and similar settings. Declarations Author Contribution Faustin Turamyimana: Conceptualization, Methodology, Project administration, Investigation, Data curation, Formal analysis, Resources, Writing – original draft, Writing – review & editing, Visualization, Funding acquisition. Jean Paul Dushime: Validation, review & editing. Doris Uwamahoro: Validation. Apollinaire Manirafasha : Validation Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. References Gennaro P. “Acute Abdomen in Women of Childbearing Age: Appendicitis or Pelvic Inflammatory Disease? A Systematic Review.” Biomed J Sci Tech Res [Internet]. 2021 May 10;35(4):27900–6. Available from: https://biomedres.us/fulltexts/BJSTR.MS.ID.005738.php Fagerström A, Paajanen P, Saarelainen H, Ahonen-Siirtola M, Ukkonen M, Miettinen P, et al. Non-specific abdominal pain remains the most common reason for acute abdomen: 26-year retrospective audit in one emergency unit. Scand J Gastroenterol [Internet]. 2017 Oct 3;52(10):1072–7. Available from: https://doi.org/10.1080/00365521.2017.1342140 Gilling-Smith C, Panay N, Wadsworth J, Beard RW, Touquet R. Management of women presenting to the accident and emergency department with lower abdominal pain. Ann R Coll Surg Engl. 1995 May;77(3):193–7. Jivraj S, Farkas A. Gynaecological causes of abdominal pain. Surg [Internet]. 2015;33(5):226–30. Available from: https://www.sciencedirect.com/science/article/pii/S0263931915000459 The jamovi project (2025). [Internet]. Vol. 15, African Journal of Emergency Medicine. 2025. p. 100895. Available from: https://www.sciencedirect.com/science/article/pii/S2211419X25000357 Hatipoglu S, Hatipoglu F, Abdullayev R. Acute right lower abdominal pain in women of reproductive age: clinical clues. World J Gastroenterol. 2014 Apr;20(14):4043–9. Gaitán HG, Reveiz L, Farquhar C, Elias VM. Laparoscopy for the management of acute lower abdominal pain in women of childbearing age. Cochrane database Syst Rev. 2014 May;2014(5):CD007683. Mjema KM, Sawe HR, Kulola I, Mohamed AS, Sylvanus E, Mfinanga JA. Aetiologies and outcomes of patients with abdominal pain presenting to an emergency department of a tertiary hospital in Tanzania: a prospective cohort study. BMC Gastroenterol. 2020;20(1):16. Helbig L, Möckel M, Fischer-Rosinsky A, Slagman A. Non-Traumatic Abdominal Pain. Vol. 120, Deutsches Arzteblatt international. Germany; 2023. p. 613–4. Additional Declarations No competing interests reported. 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\u003cli\u003eWomen\u0026rsquo;s abdominal pain is understudied in Rwanda and wider Africa.\u003c/li\u003e\n \u003cli\u003eLimited diagnostic resources delay recognition of gynecological emergencies.\u003c/li\u003e\n \u003cli\u003ePost-surgical adhesions remain a leading preventable cause regionally.\u003c/li\u003e\n \u003cli\u003eEmergency triage strengthening reduces preventable deaths in African hospitals.\u003c/li\u003e\n \u003cli\u003eFindings inform regional policies on women\u0026rsquo;s emergency and surgical care.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Introduction","content":"\u003cp\u003eAcute non-traumatic abdominal pain is of particular concern in emergency medicine, as it is a frequent and complex presenting complaint with a broad differential diagnosis. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) In non-pregnant women, this diagnostic challenge requires careful distinction between gastrointestinal, urological, gynecological, and obstetric etiologies. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Gynecological conditions often predominate and include primary dysmenorrhea, endometriosis, mittelschmerz, pelvic inflammatory disease, ovarian cyst accidents, and adhesions. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eIn Rwanda, acute abdominal pain represents 10.4% of all emergency department (ED) consultations. Although general data are available, the specific etiologies, management approaches, and outcomes for non-pregnant female patients with abdominal pain have not been well characterized in this context. This secondary analysis of a prospective study aims to describe the clinical profile, management, and outcomes of non-pregnant female patients presenting with acute abdominal pain to the ED of a Rwandan tertiary teaching hospital.\u003c/p\u003e\u003cp\u003e.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign and Research Setting\u003c/h2\u003e\u003cp\u003eThe study is a secondary data analysis of a prospective cohort study conducted at the Emergency Department of the University Teaching Hospital of Kigali (CHUK), the largest tertiary hospital in Rwanda. The original cohort, published by Turamyimana et al. in the African Journal of Emergency Medicine, included patients aged 16years or older presenting with acute non-traumatic abdominal pain between October 1, 2023, and February 29, 2024. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) For this analysis, we excluded male patients and focused exclusively on female patients.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy procedure\u003c/h3\u003e\n\u003cp\u003eThe original dataset prospectively recorded demographic information, clinical features, investigations, management approaches, complications, and outcomes. For this secondary analysis, data were extracted for females (all presented knowing they are not pregnant) patients. The primary outcome was in-hospital mortality, while secondary outcomes included predictors of death.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using the Jamovi platform version 2.7.6.0 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.jamovi.org/\u003c/span\u003e\u003cspan address=\"https://www.jamovi.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Descriptive statistics were used to summarize baseline characteristics, clinical features, etiologies, management, and outcomes. Binomial logistic regression was used to assess predictors of mortality. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Consideration\u003c/h3\u003e\n\u003cp\u003eThis secondary analysis used data from a prospective cohort study conducted at the Emergency Department of the University Teaching Hospital of Kigali (CHUK) between October 1, 2023, and February 29, 2024. The original study was approved by the Institutional Review Board of the College of Medicine and Health Sciences, University of Rwanda (Approval No. 370/CMHS IRB/2023), and by the Ethics Committee of CHUK (Approval Ref. EC/CHUK/159/2023). Both committees reviewed and approved the informed consent process. Written informed consent was obtained from all participants, covering study purpose, voluntary participation, confidentiality, and the right to withdraw without affecting their care. This secondary analysis was conducted under the same approvals.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eWith 261 patients included in the original study, 111 patients were females. The mean age for female patients was 38.3 (\u0026plusmn;\u0026thinsp;18.1 standard deviation).\u003c/p\u003e\u003cp\u003eAmong non-pregnant women presenting with acute abdominal pain (N\u0026thinsp;=\u0026thinsp;111), 37.8% (N\u0026thinsp;=\u0026thinsp;42) were classified as unstable (orange or red triage). Pain was most often diffuse 53.2% (N\u0026thinsp;=\u0026thinsp;59), followed by epigastric 17.1% (N\u0026thinsp;=\u0026thinsp;19) and hypogastric 10.8% (N\u0026thinsp;=\u0026thinsp;12). The most frequent associated symptoms were non-bilious vomiting 38% (N\u0026thinsp;=\u0026thinsp;42), abdominal distension 35% (N\u0026thinsp;=\u0026thinsp;39), constipation 32.4% (N\u0026thinsp;=\u0026thinsp;36), gas arrest 27.9% (N\u0026thinsp;=\u0026thinsp;31), and fever 20.7% (N\u0026thinsp;=\u0026thinsp;23). Relevant past medical history included hypertension 5.4% (N\u0026thinsp;=\u0026thinsp;6), peptic ulcer disease 5.4% (N\u0026thinsp;=\u0026thinsp;6), diabetes 2.7% (N\u0026thinsp;=\u0026thinsp;3), and retroviral disease 3.6% (N\u0026thinsp;=\u0026thinsp;4), while 7.2% (N\u0026thinsp;=\u0026thinsp;8) had prior abdominal surgery. On clinical examination, diffuse abdominal tenderness was noted in 36.9% (N\u0026thinsp;=\u0026thinsp;41), abdominal distension in 36% (N\u0026thinsp;=\u0026thinsp;40), and epigastric tenderness in 31.5% (N\u0026thinsp;=\u0026thinsp;35), with rebound tenderness in 10.8% (N\u0026thinsp;=\u0026thinsp;12). The leading etiologies were intestinal obstruction 20.7% (N\u0026thinsp;=\u0026thinsp;23), non-specific abdominal pain 17.1% (N\u0026thinsp;=\u0026thinsp;19), peptic ulcer disease 11.7% (N\u0026thinsp;=\u0026thinsp;13), biliary colic/cholecystitis/liver abscess 9% (N\u0026thinsp;=\u0026thinsp;10), gastroenteritis 9% (N\u0026thinsp;=\u0026thinsp;10), peritonitis 8.1% (N\u0026thinsp;=\u0026thinsp;9), and malignancy 6% (N\u0026thinsp;=\u0026thinsp;7). Less frequent causes (\u0026le;\u0026thinsp;5%) included adnexal masses 4.5% (N\u0026thinsp;=\u0026thinsp;5), tubo-ovarian abscesses 2.7% (N\u0026thinsp;=\u0026thinsp;3), and intra-abdominal abscesses 2.7% (N\u0026thinsp;=\u0026thinsp;3). A full detailed table of triage categories, locations, symptoms, past history, clinical findings, and etiologies is provided as Supplementary Table\u0026nbsp;1.\u003c/p\u003e\u003cp\u003eNearly half of the non-pregnant women with abdominal pain (46.8%, N\u0026thinsp;=\u0026thinsp;52) were managed by the surgical team (Table\u0026nbsp;1). Interventional management was required in 27.9% of patients, including 26.1% (n\u0026thinsp;=\u0026thinsp;29) who underwent abdominal surgery, one who had a colonoscopy, and one who had cystoscopy with bilateral stent placement. Gynecological causes accounted for 8.1% of cases, including adnexal masses (4.5%), tubo-ovarian abscesses (2.7%), and 1 case of ruptured ectopic pregnancy (0.9%). Overall, 18% (n\u0026thinsp;=\u0026thinsp;20) were managed conservatively. Most non-surgical cases were treated as outpatients (30.6%, n\u0026thinsp;=\u0026thinsp;34), while 19.8% (n\u0026thinsp;=\u0026thinsp;22) required admission to internal medicine. A small group (n\u0026thinsp;=\u0026thinsp;5) was managed in the Emergency Department and discharged home, including two cases of intestinal obstruction treated conservatively and three medical cases.\u003c/p\u003e\u003cp\u003eTable 1.\u0026nbsp;Baseline characteristics and clinical features of non-pregnant women with acute abdominal pain\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriage categories by locally modified South Africa Triage Scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eOrange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eRed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e4.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eUnstable patient(orange and red)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e37.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation of symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eDiffuse abdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e53.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eEpigastric pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e17.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eHypogastric pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e10.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eRight upper quadrant pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e9.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003ePeriumbilical pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eOther locations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e2.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssociated symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eNon-bilious vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e37.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eAbdominal distension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e35.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eConstipation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e32.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eGas arrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e27.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e20.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eHeadache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e9.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eBilious vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e8.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eWeight loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eJaundice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eDysuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eCough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eAltered mental status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e2.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e3.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eHerbal Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e2.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e1.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePast medical history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e5.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e2.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003ePeptic Ulcer Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e5.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eRetroviral disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e3.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eHepatitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e0.09%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eAbdominal surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e7.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical findings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eAbdominal distension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e36%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eDiffuse abdominal tenderness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e36.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eEpigastric tenderness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e31.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eHypogastric tenderness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e16.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eRight upper quadrant tenderness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eRight lower quadrant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eLeft upper quadrant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e3.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eLeft lower quadrant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e7.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003ePeriumbilical tenderness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e8.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eRight frank tenderness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e4.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eLeft frank tenderness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e2.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eRebound tenderness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e10.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eGuarding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e2.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMain etiology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eIntestinal obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e20.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eNon- specific abdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e17.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003ePeptic ulcer diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e11.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eBiliary colic/cholecystitis/liver abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e9.%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eGastroenteritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e9.%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003ePeritonitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e8.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eMalignancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eAdnexal masses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e4.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eUrinary tract infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e3.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eIntra-abdominal abscesses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e2.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eTubo-ovarian abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e2.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eUreteric colic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e1.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eRuptured ectopic pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e0.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003ePancreatitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e0.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60.5996%;\"\u003e\n \u003cp\u003eDolichocolon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.2013%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1991%;\"\u003e\n \u003cp\u003e0.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eOutcome measures\u003c/h2\u003e\u003cp\u003eAmong the 111 patients, nine died, giving a mortality rate of 8.1%. Factors significantly associated with death are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Age\u0026thinsp;\u0026ge;\u0026thinsp;75 years (OR 7.0; 95% CI 1.09\u0026ndash;45.1; p\u0026thinsp;=\u0026thinsp;0.041), abdominal distension (OR 17.5; 95% CI 2.10\u0026ndash;145.9; p\u0026thinsp;=\u0026thinsp;0.008), malignancy (OR 16.96; 95% CI 3.70\u0026ndash;77.8; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and acute liver injury (OR 6.79; 95% CI 1.39\u0026ndash;33.1; p\u0026thinsp;=\u0026thinsp;0.018) were independently associated with mortality.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRisk factors for in-hospital mortality\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRisk factor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOdd ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% Confidence interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge \u0026ge;75 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.087\u0026ndash;45.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistended abdomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.10\u0026ndash; 145.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMalignancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.701\u0026ndash;77.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcute liver injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.392\u0026ndash;33.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAbdominal pain in women is a common presentation among women in the emergency department, with etiologies including both gynecological and non-gynecological conditions(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In our study, non-gynecological predominated, with intestinal obstruction and other gastrointestinal disorders accounting for 60.3% of cases. This contrasts with the findings of Gilling Smith et al, where gynecological conditions were more frequent(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). There are similar findings to our study by Hagipoglu et al., where gastrointestinal conditions were predominate cause in two-third of cases. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Nonspecific abdominal pain was less common in other studies; however, it may mask an underlying specific diagnosis, as noted by Gaitan et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Mortality in our study cohort was high but comparable to the regional rate, such as in Tanzania(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), but mostly related to high age, distended abdomen, malignancy, and acute liver injury. This mortality is higher than that found in Germany, of 2.6% exclusive for female patients. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThese findings provide insight into the burden and outcomes of acute abdominal pain among non-pregnant women in Rwanda.\u003c/p\u003e\n\u003ch3\u003eLimitations of the study\u003c/h3\u003e\n\u003cp\u003eThis secondary analysis is subject to several limitations. First, selection bias is possible since the most severely ill patients were often unable to provide consent; inclusion of such patients might have led to even higher mortality estimates. Second, as a single-center study from a tertiary-care teaching hospital, the findings may not be generalizable to rural or lower-level facilities. Third, the analysis was restricted to variables collected in the original study, meaning that comorbidities, socioeconomic status, and healthcare-seeking behavior could not be assessed. Subgroup analyses further reduced the sample size, limiting statistical power. Finally, we did not follow patients after ED discharge, so outcomes such as repeat visits, complications, or deaths in the community were not captured. Despite these limitations, the prospective cohort design, standardized triage, and focus on a previously understudied group of non-pregnant women with acute abdominal pain strengthen the validity and relevance of our findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAbdominal pain complaints in women are a common presentation in Rwandan emergency departments, with nearly half of the patients having had surgical conditions. Only about a quarter required interventional management (27.9%), most of whom underwent abdominal surgery (26.1%). While non-gynecological causes predominated, gynecological conditions still represented a meaningful proportion and should not be overlooked. Patients with non-specific abdominal pain warrant careful evaluation with gynecological consultation or laparoscopic assessment to uncover otherwise missed pathology. Women of reproductive age should always be screened for pregnancy and investigated for tubo-ovarian or adnexal pathology. The predominance of intestinal obstruction, largely due to post-surgical adhesions, underscores the need for preventive strategies and vigilant postoperative follow-up. Early recognition and prioritization of high-risk patients, particularly older women and those presenting with abdominal distension, malignancy, or acute liver injury, may enable more timely surgical and oncologic interventions and help reduce mortality in resource-limited settings.\u003c/p\u003e\u003cp\u003eAlthough these findings come from a single tertiary center and should be interpreted with caution, given potential selection bias and absence of post-discharge follow-up, the prospective, systematically collected dataset from the country\u0026rsquo;s largest referral hospital strengthens the validity and regional relevance of the results.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eDissemination of results\u003c/h2\u003e\u003cp\u003eWe will share the results of this secondary analysis mainly through academic and professional channels. The findings will appear in peer-reviewed journals and be presented at scientific conferences, both internationally and regionally, to help expand knowledge about abdominal pain in emergency departments. Locally, we will communicate the results to CHUK leadership, the Ministry of Health, and clinical teams to support policy and practice improvements. We will also use the findings in academic discussions and training programs to strengthen emergency care in Rwanda and similar settings.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eFaustin Turamyimana: Conceptualization, Methodology, Project administration, Investigation, Data curation, Formal analysis, Resources, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing, Visualization, Funding acquisition. Jean Paul Dushime: Validation, review \u0026amp; editing. Doris Uwamahoro: Validation. Apollinaire Manirafasha : Validation\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDeclaration of competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGennaro P. \u0026ldquo;Acute Abdomen in Women of Childbearing Age: Appendicitis or Pelvic Inflammatory Disease? A Systematic Review.\u0026rdquo; Biomed J Sci Tech Res [Internet]. 2021 May 10;35(4):27900\u0026ndash;6. Available from: https://biomedres.us/fulltexts/BJSTR.MS.ID.005738.php\u003c/li\u003e\n\u003cli\u003eFagerstr\u0026ouml;m A, Paajanen P, Saarelainen H, Ahonen-Siirtola M, Ukkonen M, Miettinen P, et al. Non-specific abdominal pain remains the most common reason for acute abdomen: 26-year retrospective audit in one emergency unit. Scand J Gastroenterol [Internet]. 2017 Oct 3;52(10):1072\u0026ndash;7. Available from: https://doi.org/10.1080/00365521.2017.1342140\u003c/li\u003e\n\u003cli\u003eGilling-Smith C, Panay N, Wadsworth J, Beard RW, Touquet R. Management of women presenting to the accident and emergency department with lower abdominal pain. Ann R Coll Surg Engl. 1995 May;77(3):193\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eJivraj S, Farkas A. Gynaecological causes of abdominal pain. Surg [Internet]. 2015;33(5):226\u0026ndash;30. Available from: https://www.sciencedirect.com/science/article/pii/S0263931915000459\u003c/li\u003e\n\u003cli\u003eThe jamovi project (2025). [Internet]. Vol. 15, African Journal of Emergency Medicine. 2025. p. 100895. Available from: https://www.sciencedirect.com/science/article/pii/S2211419X25000357\u003c/li\u003e\n\u003cli\u003eHatipoglu S, Hatipoglu F, Abdullayev R. Acute right lower abdominal pain in women of reproductive age: clinical clues. World J Gastroenterol. 2014 Apr;20(14):4043\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eGait\u0026aacute;n HG, Reveiz L, Farquhar C, Elias VM. Laparoscopy for the management of acute lower abdominal pain in women of childbearing age. Cochrane database Syst Rev. 2014 May;2014(5):CD007683. \u003c/li\u003e\n\u003cli\u003eMjema KM, Sawe HR, Kulola I, Mohamed AS, Sylvanus E, Mfinanga JA. Aetiologies and outcomes of patients with abdominal pain presenting to an emergency department of a tertiary hospital in Tanzania: a prospective cohort study. BMC Gastroenterol. 2020;20(1):16. \u003c/li\u003e\n\u003cli\u003eHelbig L, M\u0026ouml;ckel M, Fischer-Rosinsky A, Slagman A. Non-Traumatic Abdominal Pain. Vol. 120, Deutsches Arzteblatt international. Germany; 2023. p. 613\u0026ndash;4. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"acute abdominal pain, women’s abdominal pain, non-traumatic abdominal pain, clinical outcomes, Emergency triage","lastPublishedDoi":"10.21203/rs.3.rs-7706524/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7706524/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcute non-traumatic abdominal pain in non-pregnant women is common in emergency units. Determining its etiology can be challenging, particularly in childbearing age, and requires prompt management. However, women’s abdominal pain has not been studied separately in Rwanda or in the region.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo describe the clinical profile, etiologies, management, and outcomes of non-pregnant women presenting with acute non-traumatic abdominal pain at the Rwanda tertiary hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSecondary analysis of a prospective cohort at the University Teaching Hospital of Kigali (October 2023 - February 2024). Descriptive statistics, summarized presentation, and etiologies; logistic regression identified predictors for in-hospital mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe included 111 women (mean age of 38.3 ± 18.1 years; median age 34). At triage, 37.8% were unstable (Orange 33.3%, Red 4.5%). Pain was most often diffuse (53.2%), epigastric (17.1%), hypogastric (10.8%), or right upper quadrant (9.9%). Surgical diagnosis accounted for 46.8% of cases; 27.9%-received interventions, including 26.1% undergoing abdominal surgery. Leading etiologies were intestinal obstruction (20.7%, largely due to adhesions), non-specific abdominal pain (17.1%), peptic ulcer disease (11.7%, gastroenteritis (9.0%), biliary disease or liver abscess (9.0%, peritonitis (8.1%) and malignancy (6.3%). Gynecological causes contributed 8.1% (Adnexal masses 4.5%, Tubo-ovarian abscess 2.7%, and ruptured ectopic pregnancy at 0.9%). Mortality was 8.1% (9/111). Predictors of death included age ≥ 75 years (OR 7.0; p = 0.041, CI: 1.087–45.1), objectified abdominal distension (OR 17.5; p = 0.008, CI: 2.1—145.87), malignancy (OR 16.96; p \u0026lt; 0.001, CI: 3.701–77.76), and acute liver injury (OR 6.79; p = 0.018 CI: 1.392–33.09).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNon-pregnant women with acute abdominal pain frequently present unstable conditions, with nearly half having surgical diagnoses and substantial mortality. Non-specific abdominal pain warrants gynecological assessment and, where available, laparoscopy to avoid missed diagnosis. Broader differential diagnosis, especially in older patients and those with abdominal distension, malignancy, liver injury, and timely surgical or oncological management, may improve outcomes. Strengthening early identification and treatment of high-risk conditions is essential to reducing mortality in this population.\u003c/p\u003e","manuscriptTitle":"Acute abdominal pain in non-pregnant women presenting to the University Teaching Hospital in Rwanda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-13 10:44:52","doi":"10.21203/rs.3.rs-7706524/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"59eec3e8-46df-4434-a161-64b1b6deb591","owner":[],"postedDate":"October 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-02T11:40:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-13 10:44:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7706524","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7706524","identity":"rs-7706524","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}