Abdominal Pain in a Woman Taking Benzos and Narcotics

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Background

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).

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Noah Gudel, Lisa M. Rock. Gastro Case Challenge: Excruciating Abdominal Pain in a Woman Taking Benzodiazepines and Narcotics - Medscape - Dec 07, 2022.

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