Gastro Case Challenge: Excruciating Abdominal Pain in a Woman Taking Benzodiazepines and Narcotics

Noah Gudel, DO; Lisa M. Rock, MD


December 07, 2022

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.


A 51-year-old woman presents with severe abdominal pain. She states that the pain started 9 months ago and occurs about every 3-4 weeks, with each episode lasting 2-3 days at a time. She describes the pain as "excruciating" when it occurs, causing her to double over, and it is diffuse across the abdomen. Although no episodes of emesis have occurred, severe nausea is associated with the pain.

The patient cannot cite any alleviating or aggravating factors. The pain does not improve after a bowel movement, and she has noticed no changes in her bowel habits. The pain has not affected her appetite, and she denies having fever, chills, melena, or hematochezia.

The patient has not experienced any recent weight loss. Her medical history is significant for gastroesophageal reflux disease, irritable bowel syndrome, bilateral ovarian cysts, and depression. Her medications include esomeprazole, aspirin, bupropion, and alprazolam, as needed. She is also taking acetaminophen/hydrocodone as needed for abdominal pain.

The patient's surgical history is significant for a vaginal hysterectomy. The family and social histories are noncontributory.

The patient notes that in the past 9 months, she has had CT of the abdomen and pelvis, as well as colonoscopy; the results of both studies were unremarkable at that time (except for the previously diagnosed ovarian cysts).


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.