title: Dengue fever may mislead the surgeons when it presents as an acute abdomen.
abstract: OBJECTIVE
  To review the management experience of a consecutive series of patients presenting as acute surgical abdomen whom were ultimately diagnosed to have DF (Dengue fever)/DHF (Dengue hemorrhagic fever).
  
  
  METHODS
  Clinical data of all cases of apparent acute abdomen (AA) which were later confirmed as having DF/DHF reviewed by two surgical units from December 2012 to December 2013 were analyzed. Initially confirmed patients with DF/DHF who developed abdominal symptoms were not considered.
  
  
  RESULTS
  Out of the seventeen cases (7 males, age range 10-71 years) presented with fever and AA; appendicitis, cholecystitis, pancreatitis and non-specific peritonitis were suspected initially in 8, 5, 1 and 3 cases, respectively. Neutropenia or thrombocytopenia signifying DF/DHF occurred only in 11 patients at first evaluation thus six remained as surgical candidates beyond 24 h. One patient underwent appendicectomy with a prolonged hospital stay. DF was confirmed by serology in all patients, latest by fourth day of admission. One required blood product transfusion, 4 needed critical care treatment and there was 1 death.
  
  
  CONCLUSIONS
  DF/DHF misleads the clinicians when it presents as AA. Initial hematological and ultrasonographic findings may be equivocal creating a diagnostic and management dilemma. Vigilant clinical suspicion and early dengue serological assessment is advisable in equivocal cases of AAs with fever in dengue endemic areas, to confirm/exclude the infection in order to avoid unnecessary surgical morbidity in the presence of DF.
authors.affiliation: Department of General Surgery, National Hospital of Sri Lanka, Colombo 10, Sri Lanka; Department of General Surgery, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. Electronic address: bingumalj@gmail.com.
authors.forename: Bingumal
authors.initials: B
authors.lastname: Jayasundara
authors.affiliation: Department of General Surgery, National Hospital of Sri Lanka, Colombo 10, Sri Lanka; Department of General Surgery, Colombo South Teaching Hospital, Kalubowila, Sri Lanka.
authors.forename: Lalith
authors.initials: L
authors.lastname: Perera
authors.affiliation: Department of General Surgery, National Hospital of Sri Lanka, Colombo 10, Sri Lanka.
authors.forename: Ajith
authors.initials: A
authors.lastname: de Silva
keywords: Acute abdomen; Acute cholecystitis; Appendicitis; Dengue hemorrhagic fever