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.
A 70-year-old woman presents to the emergency department (ED) with progressive abdominal pain. This is her second episode; she recently presented to the ED with similar complaints. Over the past few years she has experienced multiple short periods of abdominal pain that always resolve spontaneously a few hours after taking over-the-counter analgesics or with the administration of intravenous analgesics, bowel rest, intravenous fluid, and supportive treatment at visits to her primary care provider and other medical venues. At these previous visits, all laboratory and radiologic investigations have always been unremarkable, and the patient has always been discharged home.
At this visit, as a result of increased intensity of the abdominal pain and the development of mild distention, she is admitted to the hospital. She is noted to have two episodes of vomiting and a normal bowel movement while in the ED. Her past medical history is remarkable for insulin-dependent diabetes and hypertension, for which she is on antihypertensive medications. She also takes daily aspirin. She underwent a laparoscopic cholecystectomy 15 years ago but has no other history of surgery.
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Cite this: Ehab H. Youssef. A 70-Year-Old Woman With Progressive Abdominal Pain - Medscape - Aug 09, 2016.