28-Year-Old Writer With Bilious Vomiting

Richard Lucidi, MD; Jordan Hylton, DO


November 13, 2023

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A 28-year-old woman (G1P1001) presents to the emergency department after experiencing 14 hours of nonbloody, bilious emesis and constant abdominal cramping along her lower abdomen. She reports that her symptoms worsen with oral intake and denies relieving factors. She has tried oxycodone/acetaminophen at home, without relief. She also notes new onset of watery, nonbloody diarrhea after arrival to the emergency department. She denies any contact with ill friends or family.

The patient was an anonymous egg donor for an infertile couple and just returned from a trip to California, where she had oocyte retrieval 3 days ago. Upon review of systems, the patient notes limited deep inhalation, which she experienced during chest radiography.

The patient is a writer who lives at home with her husband and one child, age 4 years. She does not use alcohol, tobacco, or illicit drugs. Her last menstrual cycle was 14 days before presentation. She reports a surgical history that included cholecystectomy 5 years ago and a cesarean delivery for transverse lie in the same year. She takes loratadine for seasonal allergies and notes that she took her "trigger shot" before egg retrieval.


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