The Diagnostic Value of D-Dimer Testing in the Differential Diagnosis of Acute Abdomen in the Emergency Department.

Acute abdominal pain is one of the most common presentations in the emergency department, and encompasses a broad spectrum of conditions, ranging from self-limiting inflammatory diseases to life-threatening vascular emergencies. Although D-dimer is well established in the diagnostic work-up of venous thromboembolism and acute aortic syndromes, its role in the evaluation of acute abdomen remains incompletely defined. This narrative review summarizes and critically appraises the current evidence regarding the diagnostic utility of D-dimer across the major causes of acute abdomen. Available data indicate that D-dimer has its greatest clinical value in vascular and ischemic conditions, particularly acute mesenteric ischemia, where its high sensitivity may support rule-out strategies in carefully selected low-risk patients. In contrast, although D-dimer concentrations are frequently elevated in appendicitis, pancreatitis, bowel obstruction, diverticulitis, and gynecological emergencies, its limited specificity precludes its use as a primary diagnostic test in these disorders. Based on the available evidence, we propose a practical emergency department diagnostic framework emphasizing selective rather than routine D-dimer testing. D-dimer should be regarded as an adjunct to clinical evaluation and appropriate imaging, not a stand-alone diagnostic test, with its greatest contribution being the early recognition or exclusion of time-critical vascular abdominal emergencies.