[Acute abdominal pain in immunodepressed patients]

Abdominal pain in immunodepressed patients is a challenge. Clinical presentation is often initially very vague and it is difficult to know if a patient needs early surgical exploration or not. Even in case of peritonitis, bowel function is normal in most of the patients, and signs of peritoneal irritation are minimal and frequently absent. Mortality and morbidity should decrease if diagnosis of peritonitis is made at an early stage. A high level of suspicion must be maintained when an immunodepressed patient presents with any abdominal pain. If pain persists, aggressive diagnostic efforts should be made, and early abdominal exploration should be considered. Laparoscopy has been demonstrated to be a secure and effective method for abdominal exploration and can be considered for diagnosis. Laparotomy should stay the procedure of choice when surgical treatment is needed in these critically ill patients.