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In severe cases more testing may be required such as laparoscopy, intra-abdominal bacteria sampling and culturing, or tissue biopsy.

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Cecil Essentials of internal medicine Ninth Edition. Medicine has evolved dramatically during the past centuryfrom a healing art in which standards of practice were established on the basis of personal experience passed on from one practitioner to the next to a rigorous intellectual discipline reliably steeped the scientific method.

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