A 65-Year-Old Man With a Hugely Distended Abdomen

Prashanth Rawla, MD; Jeffrey Pradeep Raj, MD


October 24, 2019

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 65-year-old white man presents to the emergency department with a hugely distended abdomen. He states that his abdomen has been progressively distending over the past 4 days. He describes decreased appetite and nausea but no vomiting. He also describes abdominal discomfort and mild diffuse pain. He states that the last time he had a bowel movement was 5 days ago. He is passing flatus.

The patient denies any fever, chills, or chest pain. He mentions that he has difficulty breathing. His medical history is significant for hypothyroidism, for which he is taking levothyroxine. He has also been diagnosed with chronic obstructive pulmonary disease (COPD), for which he uses an albuterol inhaler and a budesonide and formoterol inhaler. He also has hypertension, for which he takes amlodipine, and hyperlipidemia, for which he takes atorvastatin.

His past surgical history is significant for a meniscal tear repair in his right knee. The patient reports a 50–pack-year smoking history and denies any significant history of alcohol use or illegal drug use.

He was recently admitted to the hospital for a COPD exacerbation and acute bronchitis. He had a prolonged stay in the hospital (7 days) and was treated with intravenous methylprednisolone, levofloxacin, albuterol, budesonide, and arformoterol. He was discharged home on a tapering course of oral prednisone 4 days ago.


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