Tropical medicine and the acute abdomen.

In conclusion, the most important task in evaluating an immigrant or traveler with abdominal pain is to consider the myriad tropical diseases that mimic common western conditions. A careful history may point to antecedent symptoms and a time course that are incompatible with typical appendicitis, biliary colic, or bowel obstruction, but physical examination is generally not specific enough to differentiate between tropical and ordinary abdominal crises. Blood work for eosinophilia and a rapid examination of the stools by an experienced technician may indicate a need for judicious delay in exploratory laparotomy. In this interval, imaging studies, serologic tests, and therapeutic drug trials may clarify the diagnosis.