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

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. 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.