Clinical Profile and Management Outcomes of Acute Non-Traumatic Abdominal Pain in Non-Pregnant Women at a Rwandan Tertiary Hospital: A Secondary Analysis of a Prospective Cohort

Background Emergency department (ED) consultation for acute non-traumatic abdominal pain is a frequent occurrence and accounts for approximately 10.4% of all ED consultations in Rwanda. In non-pregnant women, particularly those of reproductive age, identifying the underlying etiology can be challenging because abdominal pain may arise from gastrointestinal, urological, or gynecological conditions. Despite the frequency of this presentation, research specifically focusing on non-pregnant women in Rwanda and the wider East African region remains limited. Method This study is a secondary analysis of a prospective cohort conducted at the Emergency Department of the University Teaching Hospital of Kigali (CHUK) between October 2023 and February 2024. Due to local triage pathways, women with suspected or confirmed pregnancy are typically referred directly to obstetrics and gynecology. Therefore, women presenting to the ED with abdominal pain are initially managed as non-pregnant unless pregnancy is identified during routine diagnostic evaluation. For this analysis, we included female patients who self-reported as not pregnant at presentation. Descriptive statistics summarized clinical characteristics, etiologies, management approaches, and outcomes. Binomial logistic regression was used to identify predictors of in-hospital mortality. Results A total of 111 non-pregnant women were included, with a mean age of 38.3 years (SD ± 18.1). At triage, 37.8% presented in unstable conditions (orange or red categories). Pain was most frequently diffuse (53.2%), followed by epigastric (17.1%) and suprapubic (10.8%) locations. Surgical diagnoses accounted for 46.8% of cases, with intestinal obstruction (20.7%) being the leading etiology. Although participants initially reported that they were not pregnant at presentation, diagnostic evaluation identified one case of ruptured ectopic pregnancy, which represented the only pregnancy-related cause of abdominal pain in the cohort. Gynecological causes accounted for 8.1% of the overall cases. The overall mortality rate was 8.1%. Independent predictors of death included age ≥ 75 years (OR 7.0), abdominal distension (OR 17.5), malignancy (OR 16.96), and acute liver injury (OR 6.79). Conclusion Non-pregnant women presenting with acute abdominal pain frequently have high clinical acuity and significant surgical disease. Early identification of high-risk indicators such as advanced age, abdominal distension, malignancy, and liver injury is essential for improving outcomes in resource-constrained emergency settings.