Paroxysmal abdominal pain is most often seen in patients with intestinal spasm or intestinal obstruction. Patients may have pain accompanied by nausea, vomiting, marked abdominal distention, and even diarrhea or material with blood in the bowel movements, black stools, or blood-like stools. The vomit can have bloody stomach contents, especially in patients with high small bowel obstruction. In the presence of abdominal infection, the patient may also have chills and high fever, with significant positive percussion with mobile turbid sounds and pressure pain throughout the abdomen. In the presence of peritonitis, there are also obvious signs of peritoneal irritation, requiring urgent elective caesarean surgery. Some patients with pancreatitis may also present with petechiae in the abdomen, around the umbilicus, or in the rib cage, and laboratory tests may show hypocalcemia, indicating a very serious condition that requires surgery if necessary.