Triple Trouble in the Abdomen

​BY LAURIE-ANN​ ANTOINE; MOHIT S. MAHALAN; & AHMED RAZIUDDIN, MDA 32-year-old afebrile woman presented to the emergency department in acute distress from abdominal pain, which she described as severe and crampy. The pain had begun approximately six hours prior to her visit to the hospital, and was associated with nausea and intractable, bilious vomiting. The patient consumed one dose of liquid bismuth subsalicylate, but it did not provide relief.The patient's last bowel movement was several hours prior to her arrival at the hospital and was nonbloody. Her past medical and surgical history were unremarkable. The patient's last menstrual period ended one week earlier and was regular in timing and duration. She had been using oral contraceptives, but denied using tobacco, alcohol, and recreational drugs.Her abdomen was not distended with high-pitched bowel sounds, and she had tenderness in the left lower quadrant and periumbilical region with a negative Rovsing's sign. An initial evaluation of the patient's vitals revealed a blood pressure of 141/85 mm Hg and a pulse of 63 bpm. Laboratory tests, including complete blood count with differential, comprehensive metabolic panel, coagulation profile, serum lipase, and lactic acid, revealed a mildly elevated hemoglobin count of 16.2 g/dL and a high leukocyte count (16.5 K/uL) with marked neutrophilia. Other abnormalities were a decreased carbon dioxide value of 20 mmol/L and elevations in blood glucose, serum calcium, and tota...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research