Acute-onset abdominal pain and clinical findings suggestive of

intraabdominal
pathology necessitating emergency surgery
In these conditions, exploratory laparotomy is carried out both to diagnose the
condition and to
perform the necessary therapeutic procedure.
Patients with clinical features of peritonitis may have pneumoperitoneum on erect
chest and
abdominal radiographs. They usually have a perforated viscus, most commonly the
duodenum,
stomach, small intestine, cecum, or sigmoid colon. Exploratory laparotomy is done
first to
determine the exact cause of pneumoperitoneum, followed by the therapeutic
procedure. In the
absence of pneumoperitoneum, appendicular perforation and intestinal ischemia are
possible
diagnoses; a high index of suspicion for possible intestinal ischemia should be
maintained.
Patients with vomiting, obstipation, and abdominal distention are likely to have
intestinal
obstruction. Abdominal radiographs in these patients may reveal dilated intestinal
loops and airfluid
levels. Hernia, especially an incarcerated inguinal hernia, should be ruled out as a
possible
cause of the obstruction.
Patients with pain in the abdomen and fever may have intra-abdominal collections.
These are
usually detected by means of ultrasonography (US) or computed tomography (CT)
and can often
be managed percutaneously. A persistently high aspirate or the presence of enteric
contents may
suggest perforation, and laparotomy may be required to control the source.
Patients with vomiting, obstipation, and abdominal distention are likely to have
intestinal
obstruction. Abdominal radiographs in these patients may reveal dilated intestinal
loops and airfluid
levels. Hernia, especially an incarcerated inguinal hernia, should be ruled out as a
possible
cause of the obstruction.
Patients with pain in the abdomen and fever may have intra-abdominal collections.
These are
usually detected by means of ultrasonography (US) or computed tomography (CT)
and can often
be managed percutaneously. A persistently high aspirate or the presence of enteric
contents may
suggest perforation, and laparotomy may be required to control the source.