The presenting clinical features in a variety of medical conditions may be mistaken for those of an acute surgical abdomen. Surgical intervention, which is necessary and beneficial for patients with surgical causes of acute abdomen, is unnecessary and potentially dangerous for those in whom the acute abdominal features are manifestations of medical diseases. In order to avoid errors of omission and commission with operative intervention, it is essential that the patients with medical causes be differentiated from those with surgical causes. The differentiation is not always easy, and medical consultation should be obtained when in doubt. Nonetheless, one should always remember that diagnosis of a medical cause by no means excludes a surgical condition, since the diagnostic problem can be further complicated by concurrent medical and surgical causes. For instance, in a patient with uncontrolled diabetes mellitus ketoacidosis can produce a clinical picture of acute abdomen, conversely an acute abdominal condition can precipitate ketoacidosis. In other words, diabetic ketoacidosis may be either the cause or the consequence of an acute abdominal condition. Needless to say, the therapeutic implications vary depending on whether diabetic ketoacidosis is the cause or the consequence. In such a difficult situation aggressive treatment of the medical disorder and evaluation of the abdominal findings at frequent intervals by repeated examination is invaluable in clarifying the diagnosis.
KeywordsFamilial MEDITERRANEAN Fever Rheumatic Fever Acute Abdomen Diabetic Ketoacidosis Rectus Sheath
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