A 60-Year-Old Man With Intense Left-Sided Abdominal Pain

Pramod Gupta, MD; Jitendra Gohil, MD

Disclosures

October 12, 2016

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

Background

A 60-year-old man presents to the emergency department with a 1-day history of crampy, moderately intense, left-sided abdominal pain. The pain is constant and is exacerbated by movement; it is relieved by lying still. The patient has not experienced anorexia and has not eaten since the evening before.

He has had several loose brown stools but denies any nausea or vomiting. The stool in his bowel movements is not blood-streaked and does not appear tarry. He denies any recent travel or camping and has not eaten any uncooked or undercooked foods. He reports feeling febrile, sweaty, and generally fatigued. No urinary symptoms, such as dysuria or increased frequency, are reported. He has not had any recent contact with sick people.

He denies having had similar episodes in the past. His medical and surgical histories are unremarkable, although he did have a screening barium enema examination 3 years ago. He is a nonsmoker and denies any heavy or regular alcohol consumption. He does not take any prescription or over-the-counter medications.

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