An 85-Year-Old With Sudden-Onset Severe Abdominal Pain

James J. McCombie, MB ChB

Disclosures

October 11, 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.

Background

An 85-year-old man is presented to the emergency department (ED) by ambulance with severe abdominal pain that began suddenly 2 hours before presentation. The pain is mainly in his back and radiates toward his left inguinal region. The patient felt light-headed at the onset of the pain to the extent that he had to grip the sink to steady himself. He also reports significant nausea, although he has not vomited.

He has no urinary symptoms. His medical history includes type 2 diabetes, hypertension, hyperlipidemia, ischemic heart disease, and intermittent claudication of his lower extremities. His medications include metformin, ramipril, simvastatin, aspirin, and a glyceryl trinitrate pump spray. He smoked 10-20 cigarettes a day for over 60 years but stopped 5 years ago.

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