A 72-Year-Old Man With Abdominal Pain

Fahad M. Iqbal, MD; Preeti Singh, MD; Jayanth Koneru, MD; Vivekananda Pattabiraman, MD

Disclosures

September 15, 2015

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 you would like to suggest for a future Case Challenge, please contact us.

Background

A 72-year-old man with a medical history significant for chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, hypertension, atrial fibrillation, and prior ischemic stroke is admitted for a 1-day history of worsening abdominal pain. The pain started suddenly, is constant and diffuse, and is described by the patient as 7 out of 10 in intensity. It is not associated with oral intake. The pain is not relieved by over-the-counter pain relievers and is not exacerbated with movement.

The patient felt some nausea and has had multiple episodes of bilious emesis, but he has not had any hematemesis, hematochezia, diarrhea, or melena. He denies having fever, chills, or night sweats, as well as any history of recent abdominal trauma, weight changes, or surgery. He is currently taking metformin (Glumetza®), amiodarone (Cordarone®), baby aspirin (Bayer®), extended-release metoprolol (Toprol XL®), and amlodipine (Norvasc®).

The patient has no allergies or family history of coronary artery disease or cancer. He drinks socially and denies any illicit drug use. He has an approximately 80 pack-year smoking history.

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