Acute abdomen is one of the day-to-day occurrences in surgical casualty with cases ranging from mild acute pancreatitis to life-taking malefic perforation peritonitis. With impending progressive mortality associated with most of the cases, it demands urgent attention and apt management. The presentation may vary from a stable patient to a patient in hemodynamic instability requiring ICU and ventilator support. In addition to the usual causes of the acute abdomen which include trauma, inflammation, malignancy, and obstruction, medical illness also forms a significant bulk of cases presenting as masquerading acute abdomen. A true surgical abdomen usually warrants an exploratory laparotomy and thus clinicians have to perceive a high risk of suspicion to diagnose with a medical ailment as was our case.