The clinician initially must adopt a broad-based approach, which necessarily becomes more focused as the evaluation ensues. These arbitrary definitions are often helpful when formulating a differential diagnosis.

Abdominal pain is considered acute when it has been occurring for several days and subacute when it has been occurring more than several days but less than 6 months. Table 11-1 Differential Diagnosis of Chronic or Recurrent Abdominal PainĪbdominal pain is considered chronic when it has been occurring constantly or intermittently over at least six months. FAPS serves as a model to illustrate many of the complex issues involved in caring for patients with chronic abdominal pain. This chapter focuses on the neuromuscular causes of chronic abdominal pain and the functional abdominal pain syndrome (FAPS). Although the causes of chronic abdominal pain are varied, the pathophysiologic pathways that produce chronic pain are common to many of them. Diagnosis of a functional gastrointestinal disorder is generally considered once potential causes of organic chronic abdominal pain have been confidently excluded. Many of these diagnoses require careful consideration and clinical interrogation, in addition to appropriate diagnostic testing, to discern whether the entity is indeed the cause of the patient’s pain. Many disorders discussed elsewhere in this text can produce chronic abdominal pain ( Table 11-1). Not only is the management of chronic abdominal pain a frequently daunting task, but also the possibility of overlooking a structural or organic disorder is always a concern. Chronic abdominal pain poses a particularly challenging clinical problem. Abdominal pain can be benign and self-limited or a harbinger of a serious life-threatening disease (see Chapter 10).

The evaluation of any patient with a complaint of abdominal pain is challenging. Role of Laparoscopy with Lysis of Adhesions 170

Chronic functional abdominal pain