Report and commentary on six cases

Abstract

The cases described in the following pages are examples of what has come to be known as the I, acute abdomen". Such a grouping, under so vague a terra is essentially clinical, and it is therefore proposed to lay more stress on the clinical aspect rather than on the underlying pathological conditions.All six patients were admitted to the wards of the P,oyal Infirmary as emergency cases, and most of them underwent surgical treatment within the next few hours. It is perhaps true to say that the management of this typo of case may call for a higher degree of surgical skill than any other. Most of the patients are urgently ill, and many are suffering severe pain. On these accounts, systematic examination may become undesirable or impossible, and a balance has to be struck between an over- - zealous examination on the one hand, or an inadequate investigation on the other. The diagnosis has to be arrived at by means of the simplest of clinical tests, the surgeon relying almost entirely on his unaided senses, for little aid can be gained from the laboratory, or from the more time-consuming and more highly specialised methods of examination.The decision as to the exact line of treatment to be followed has to be made rapidly, and in this respect, an estimation of the patient's general condition and suitability for operation is of prime importance. Thus, no stereotyped routine can be followed, each case requiring to be judged on its own merits.