A 28-year-old Guatemalan woman with recurrent abdominal pain fever and diarrhea

Article Abstract:

A 28-year-old Guatemalan patient was admitted to the hospital with complaints of severe abdominal pain and vomiting. During the previous 18 months she had suffered four or five intense episodes of abdominal pain that were localized to the lower left quarter of her abdomen. The attacks began several hours after eating and lasted for an extended period of days. She was given medication to relieve her symptoms and was diagnosed with colitis, inflammation of the colon. The patient had arrived in the United States approximately 2 months before her hospitalization. Her medical history was not remarkable. On examination she appeared well, liver and spleen were normal and her abdomen was soft and without any localized tenderness. Examination of her extremities, pelvis and rectum yielded similarly normal findings. Although most biochemical values were within normal range, her white-blood cell count was elevated and indicative of infection. X-ray examinations, including CAT scans, were unremarkable with the exception of areas of abnormal calcification within the abdomen near her right kidney. On the sixth day of her hospitalization, the patient experienced a cramping pain in the right upper quarter of the abdomen, and developed diarrhea, nausea and vomiting. Her temperature was elevated, and she continued to have pain in the upper right abdomen. Early on the seventh day she had severe abdominal pain, but its location had shifted to the right side, near to her navel. The shifting nature of her pain, the presence of calcium within her abdomen, and other unusual symptoms prevented the hospital staff from rapidly making the correct diagnosis, appendicitis. It is unclear whether this case represented an unusual illness, perhaps from a relative unknown South American parasite, or an unusual manifestation of a very common surgical problem. Appendicitis is usually thought of as an acute disease, but the present case typifies a chronic or recurrent appendicitis which has been recently accepted as a diagnostic category. (Consumer Summary produced by Reliance Medical Information, Inc.)

Appendicitis

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Sudden onset of abdominal pain and hematemesis in a 56-year-old woman

Article Abstract:

A 56-year-old woman with a sudden onset of upper abdominal pain and vomiting stomach contents mixed with blood, was taken to the hospital by ambulance after she became dizzy and fell. She had a previous history of stomach ulcers and alcohol abuse, but had no current ulcer symptoms. The patient's blood pressure was low. Fever and elevated white blood cell count indicated the possibility of infection. X-ray films of the patient's abdomen revealed that an area near the stomach was filled with gas. Diseases causing the patient's symptoms and test results were considered: a tear in the juncture of the stomach and the esophagus, Mallory-Weiss syndrome, and a rupture in the wall of the esophagus, Boerhaave syndrome, both associated with alcohol abuse, were possible diagnoses. During abdominal surgery a rupture in the esophagus was repaired and the Boerhaave syndrome was identified as also causing an infection in the chest cavity. The patient was fed through a stomach tube and treated with antibiotics following surgery. Additional diagnostic testing procedures are discussed.

Abnormalities, Gastrointestinal bleeding, Gastrointestinal hemorrhage, Esophagogastric junction, Kaplan, Lee M.

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A 23-year-old man with recurrent bouts of abdominal pain and vomiting

Article Abstract:

A 23-year-old obese man with a two-month history of abdominal cramping was originally diagnosed with constipation and later admitted to the hospital after the pain became severe and vomiting developed. X-ray films of the abdomen revealed a narrowing of the small bowel indicating an obstruction. The origin of the obstruction was thought to be a tumor, an intestinal polyp (protruding growth), a foreign object, or a congenital defect. Meckel's diverticulum, an abnormality of the small intestines in which remnants of the fetal yolk sac fails to disappear during fetal development and remains in the bowel, was also considered. Abdominal surgery was performed and the obstructed section of the intestines removed. Further evaluation of the tissue confirmed the diagnosis of Meckel's diverticulum.

Intestines, Gastrointestinal diseases, Intussusception, Diverticulitis, Diverticular disease, Margolies, Michael N.

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