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This chapter discusses the management of surgical abdomen. It presents special circumstances, which make management of surgical abdomen difficult in some patients, including children, developmentally delayed, or obtunded individuals (from illness or drugs), patients with spinal cord injuries, pregnant patients, elderly or immunosuppressed patients, and morbid obese patients. Patients could present with referred pain, which is pain experienced at a site (or sites) distant from the initiating organ due to a shared neural origin with another body organ, such as right shoulder pain due to biliary colic or back pain due to pancreatitis. Acute-onset pain lasting longer than 6 hours in a previously healthy patient is often due to a surgical condition. As with the stable patient, a well-formulated differential diagnosis based on careful history and physical examination guides the plan of care far better than a shotgun approach of imaging and laboratory tests.