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

Prashanth Rawla, MD; Jeffrey Pradeep Raj, MD

Disclosures

October 24, 2019

Physical Examination and Workup

Upon arrival to the emergency department, the patient has a temperature of 98.9°F (37.16°C), a heart rate of 104 beats/min, a respiratory rate of 22 breaths/min, blood pressure of 112/84 mm Hg, and 92% oxygen saturation on room air.

Upon physical examination, he appears uncomfortable and is lying in the supine position; he has dry oral mucosa. Abdominal examination reveals a very large, distended abdomen with apparent mild diffuse tenderness to palpation and without any rebound tenderness or guarding. Bowel sounds are tympanic. His abdominal pain appears out of proportion to the physical examination findings.

His laboratory values are as follows:

  • White blood cell count: 14,000 cells/µL (reference range, 4500-11,000 cells/µL)

  • Hemoglobin level: 13.9 g/dL (reference range, 13.5-17.5 g/dL)

  • Hematocrit concentration: 37% (reference range, 45%-52%)

  • Platelet count: 306,000 cells/µL (reference range, 150,000-450,000 cells/µL)

  • Sodium level: 135 mEq/L (reference range, 135-145 mEq/L)

  • Potassium level: 3.5 mmol/L (reference range, 3.6-5.2 mmol/L)

  • Chloride level: 107 mmol/L (reference range, 98-106 mmol/L)

  • Blood urea nitrogen (BUN) level: 43 g/dL (reference range, 7-20 mg/dL)

  • Creatinine level: 1.51 mg/dL (reference range, 0.6-1.2 mg/dL)

  • Glucose level: 102 mg/dL (reference level, < 100 mg/dL)

  • Aspartate aminotransferase level: 46 U/L (reference range, 10-40 U/L)

  • Alanine aminotransferase level: 41 U/L (reference range, 7-56 U/L)

  • Alkaline phosphatase level: 142 IU/L (reference range, 44-147 IU/L)

  • Amylase level: 25 U/L (reference range, 23-85 U/L)

  • Lipase level: 19 U/L (reference range, 0-160 U/L)

  • Lactic acid level: 0.7 mmol/L (reference range, 0.5-1 mmol/L)

All other laboratory values are unremarkable. An abdominal x-ray is obtained. He is admitted to the hospital on the basis of its findings. A subsequent CT scan of the abdomen/pelvis without contrast was obtained. Imaging study findings are shown below (Figures 1-4).

Figure 1.

Figure 2.

Figure 3.

Figure 4.

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