We surgeons call the abdomen the temple of surprises. No matter how good we are in physical examination and diagnosis. No matter what kind of diagnostic exam would we use to confirm our diagnosis. We are surprised by the outcome in some 20\% of cases. An acute appendicitis could turn out to be a twisted ovarian cyst or worst ectopic pregnancy. The most difficult surprise would be a case when we are not prepared to do like when a patient was diagnosed to have a gastric tumor and will turn out to be a pancreatic head tumor in the 4th stage. Most often these cases end up as an open-close surgery.
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