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BACKGROUND
A 52-year-old woman presents to the emergency department
with an acute onset of diffuse and colicky abdominal
pain accompanied by nonprojectile vomiting and a feeling
of being bloated. She states that she has had no flatus
in the last 2 days. She has no history of fever,
lightheadedness, syncope, or previous abdominal
surgeries. She takes only takes metoprolol for
hypertension.
On physical examination, her vital signs are a
temperature of 37.2°C, a heart rate of 110 beats per
minute, and a blood pressure of 138/92 mm Hg. Her
abdomen is noticeably distended, with diffuse tenderness
to palpation and focal tenderness, which is greatest in
the epigastrium. No rebound or guarding is observed.
Bowel sounds are present but hypoactive, and the shake
and heel-tap findings are negative. No Murphy sign is
noted, and no fluid thrill is elicited. Her
cardiovascular and respiratory findings are normal.
A supine abdominal radiograph is obtained, followed by
an abdominal CT scan. What is the diagnosis? |
Hint
This condition is a surgical emergency. |
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Authors:
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Jeremy Logan, MD, University
of New Mexico Hospital Residency, Department of Radiology, Albuquerque
Gautam Dehadrai, MD, Staff Physician, Department of Radiology, Veterans
Administration Hospital, Albuquerque, NM
Ali Nawaz Khan, MBBS, FRCP, FRCS, FRCR, Lecturer, Department of
Diagnostic Radiology, Faculty of Medicine, University of Manchester
Prabhakar Rajiah, MD, FRCR, Registrar, Department of Radiology, North
Manchester General Hospital NHS Trust, UK |
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eMedicine Editor:
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Rick Kulkarni, MD, Attending Physician, Director of Informatics, Department of Emergency Medicine, Olive View - UCLA Medical Center, Assistant Professor of Medicine, David Geffen School of Medicine at UCLA
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