Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 76-year-old woman presents to the emergency department (ED) with intense abdominal pain. She describes the pain as a diffuse, severe, constant ache throughout her abdomen. The pain woke her from sleep several hours ago; she felt well when going to bed last night, with no discomfort or other preceding symptoms. Today, she feels nauseous and has had 2 liquid bowel movements that were dark brown in color.
She has never had similar pain before. She denies having any fever, trauma, urinary symptoms, vaginal discharge, or bleeding. No chest pain, shortness of breath, or back pain has been noted. She has a medical history of atrial fibrillation, a myocardial infarction 2 years ago with 2 stents placed, hypertension, and chronic obstructive pulmonary disease (COPD).
She admits to being a lifelong smoker and has smoked 1-2 packs daily for at least 50 years. She has a glass of sherry nightly but denies ever using drugs. She has no history of abdominal surgery. She is a widowed homemaker who lives alone but has 2 daughters who live nearby. She has been prescribed multiple medications, including warfarin, atenolol, an ipratropium/salbutamol inhaler, lisinopril, a multivitamin, and hydrochlorothiazide. She admits to frequently missing doses of her medications and recently ran out of warfarin. She has no known drug allergies.
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Cite this: Craig A. Goolsby. A 76-Year-Old Woman With Abdominal Pain - Medscape - Sep 24, 2010.