A 70-Year-Old Man With Deteriorating Mental Status and Pain

Gamal A. Bebars, MD, FRCS; Evelyn P. Bebars, MD, FPCR


October 23, 2018

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 recognize accurately. 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 70-year-old man presents to the emergency department (ED) with generalized abdominal pain and distention. The distention has increased progressively over the last 4 days, with a substantial increase today. His mental status has progressively deteriorated, and he cannot provide additional information regarding the onset, course, and character of the pain. The patient's family states that he has not had a bowel movement in 2 days and has never experienced similar symptoms.

The patient has hypertension and has been on oral medication for his blood pressure for the past 18 years. He does not have any history of diabetes, myocardial infarction, or stroke. He has no past history of any abdominal surgery. He also has no history of travel. The patient is a nonsmoker, and he does not consume alcohol.


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