A 70-Year-Old Woman With Progressive Abdominal Pain

Ehab H. Youssef, MD, FRCR


August 09, 2016

Physical Examination and Workup

Figure 1.

Figure 2.

Upon physical examination, her oral temperature is 98.6° F (37° C), her pulse rate is 94 beats/min, and her blood pressure is 168/92 mm Hg. Overall, she is noted to be uncomfortable secondary to colicky pain.

The head and neck examination findings are normal. Her lungs are clear when auscultated, with normal respiratory effort, and her heart examination is normal except for occasional premature ventricular beats. Upon abdominal examination, some fullness of the epigastric and left upper quadrant regions is noted, with mild tenderness on deep palpation. The rest of the abdomen is soft, with no abnormal pigmentations. Small scars from the previous laparoscopic cholecystectomy are noted. Rectal examination is unremarkable. No edema is observed in the extremities.

The laboratory investigations show an elevated blood glucose level of 140.54 mg/dL (7.8 mmol/L; normal range, 75-115 mg/dL), but otherwise the patient is noted to have a normal extended metabolic panel, including lipase and liver enzymes, and a normal complete blood count (CBC), with no evidence of leukocytosis or anemia. A urinalysis is negative for blood, nitrites, and leukocytes.

Plain abdominal radiographs reveal a nonspecific bowel gas pattern (not shown) and no signs of bowel obstruction. The patient is transferred to the hospital floor for bowel rest, intravenous fluids, and antiemetics. On hospital day 2, she is noted to be in increasing pain; a general surgery consultation is requested and abdominal CT scanning is performed (Figures 1 and 2).


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