Try to read this : http://www.ncbi.nlm.nih.gov/pubmed/?term=abdominal+pain+porphyria

As you know, the acute attack in acute porphyrias (AP), that may also occur in mixed porphyrias (porphyria variegata and hereditary coproporphyria) usually consist in abdominal diffuse or localised pain associate to constipation and vomiting (the so-called Günther triad). These manifestations appear as an acute abdomen with leucocytosis, sometimes mild fever, but without neither defence nor muscle contracture of the abdominal wall.

Neurological manifestations could be very pleomorphic: polyneuritis, peripheral or cranial nerves paralysis, seizures and rarely a very severe complication respiratory palsy.

Psychiatric manifestations may be extremely variable, from changes of character to dementia crisis (Korsakoff' syndrome, delirium tremens, confusion, coma…).

These are the classical well known manifestations. As a curious anecdote I remember that long time ago I read a paper referring as possible first manifestation of acute porphyria the sudden petition of divorce…(of course the percentage of AP in divorce petition's would really be exceptionally low…!!).

In any case the anecdote is useful to answer your specific question. Yes, it is possible that a patient with AP do not present abdominal pain syndrome but other manifestations (neurological, psychiatric..).

Thank you both