Oncology Case Challenge: A 46-Year-Old Mother With Severe, Constant Abdominal Pain

Mounika Gangireddy, MD, MBBS


April 13, 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.


An otherwise healthy 46-year-old woman presents with diffuse abdominal pain that awakens her from sleep. She describes the pain as sharp, 10/10 in intensity, and constant in nature. The pain worsens with movement. She reports no fevers or chills, rectal bleeding, melena, hematemesis, vomiting, or change in bowel habits.

Polycystic ovarian syndrome was previously diagnosed in this patient and is managed with lifestyle changes. She had iron deficiency anemia from menorrhagia and took iron supplements for a brief period. She has a remote history of deep venous thrombosis and pulmonary embolism and was treated with warfarin for 6 months. Her surgical history includes a gastric bypass procedure and a myomectomy. She has never smoked and does not consume alcohol but does use cannabis occasionally. She lives with her children. She takes over-the-counter vitamin supplements. Her family history is not significant for cancers or clotting disorders.


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