An unusual cause of abdominal pain

European Respiratory Journal, 2002

SBMU publishing, 2016

A 33-year-old man presented to the emergency department ED) with complaint of 2-day history of abdominal pain. His pain developed with gradual onset prominently in epigastric area after eating dried mushrooms. The pain was diffuse, persistent, radiating to the back and aggravated by meal. He had been tolerating only liquids and had complaints of nausea and vomiting. He had no history of diabetes mellitus, hypertension, alcohol consumption, malignancy, or prior surgery. On arrival his blood pressure was 128/72 mmHg, with a heart rate of 101 beats/minute and a respiratory rate of 20 breaths/minute. He was afebrile. Physical examination revealed diffuse abdominal distention, hyper-pitched bowel sounds, and tenderness more marked over the umbilicus with no guarding or rebound tenderness. A complete blood cell count showed the following: leukocyte count 12600 /mm3; segmented neutrophils 90%; hemoglobin level of 14 mg/dl; hematocrit 30%; and platelet 420000/µL. Other laboratory studies included: glucose 101 mg/dL; serum urea nitrogen 45 mg/dL; serum creatinine 2.0 mg/dL; sodium 148 mEq/L; potassium 3.1 mEq/L; serum glutamic oxaloacetic transaminase (SGOT) 38 U/L and lipase 30 U/L. Figure 1 shows patient’s plain upright abdominal X-ray as well as coronal and axial cuts of abdominal CT scan.

Cleveland Clinic journal of medicine, 2014

Cleveland Clinic Journal of Medicine, 2018

Gastroenterology, 2012

Question: A previously healthy 64-year-old man presented to the emergency department with a 4-day duration of progressive and diffuse abdominal pain. The pain, seemingly unrelated to meals or postural change, began with intermittent cramps and progressed to a steady, constant ache. Physical examination revealed marked lower quadrant tenderness, diffuse peritoneal sign, and reduced bowel sounds. Deep tenderness at McBurney's point was not obvious. Laboratory investigation disclosed leukocytosis with a left shift, and the remaining tests were unremarkable. Contrast-enhanced computed tomography (CT) was performed (Figure A). What is your diagnosis and management? See the GASTROENTEROLOGY web site (www.gastrojournal .org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

2002

American Heart Journal, 1978

BMJ, 2009

PLoS Medicine, 2009

Internal and emergency medicine, 2018