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BACKGROUND
A 76-year-old man presents to the emergency department with sudden-onset abdominal pain of 4 hours duration. The pain is present in the upper abdomen, centered in the epigastrium, and described as deep and burning. The patient has a medical history of coronary artery disease and hypertension. He also reports having "indigestion," which caused pain similar to today's episode in his upper abdomen. In the past, food did not relieve this symptom.
On physical examination, the patient is pale and in obvious discomfort. His heart rate is 122 beats per minute, and his blood pressure is 110/65 mm Hg. Cardiovascular and respiratory findings are unremarkable, but he has tenderness in the epigastric region of his abdomen. His stool is brown and guaiac positive. Hyperactive bowel sounds are heard on auscultation. Laboratory investigations show a mild anemia with hemoglobin concentration of 127 g/L (12.7 g/dL) and BUN and creatinine values of 17.1 mmol/L (48 mg/dL) and 106 µmol/L (1.2 mg/dL), respectively.
What is the diagnosis?
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Hint
Both the inner and the outer walls of the bowel are visible. |
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Author:
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Gautam Dehadrai, MD,
Department of Radiology,
Norman Regional Hospital,
Norman, Okla
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eMedicine Editor:
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Rick G. Kulkarni, MD,
Assistant Professor,
Yale School of Medicine,
Section of Emergency Medicine,
Department of Surgery,
Attending Physician,
Medical Director,
Department of Emergency Services,
Yale-New Haven Hospital, Conn
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