What are conditions w/diagnostic uncertainty?

● Every person that comes with an acute abdominal pain of more than 6 hours ? we should rule out a surgical abdomen & the patient needs further investigation. ● Acute abdominal pain with uncertain diagnosis, and we have done everything and nothing showed ? we think about acute appendicitis (esp. retrocecal) or bowel obstruction (in case of Richter hernia or obturator hernia). ● In young women ? we think about PID, ovarian cyst rupture, ovarian torsion, salpingitis, or ectopic pregnancy. ● In case of Richter hernia (a part of the antimesenteric intestinal membrane enters the hernia and becomes incarcerated, this can cause strangulation, necrosis, perforation, and it doesn't show on exam due to absence of air fluid level), obturator hernia, proximal bowel obstruction, closed loop obstruction: absence of air fluid level. ● Elderly ? ischemia or cancer.