Acute abdominal pain and abnormal CT findings.


A 28-year-old previously healthy man developed constant midepigastric and supraumbilical abdominal pain.Oneday after theonset of pain, he presented to the emergency department. The patient described his pain intensity as 8 on a scale of 1 to 10. He also described having somenausea but no anorexia, and he experienced a single episodeof emesis in the emergencydepartment.Hewas afebrile, andhis heart ratewas86beats/min;bloodpressure, 128/86mmHg;andbody mass index, 28 (calculated asweight in kilograms divided by height in meters squared). Bilateral lower abdominal and supraumbilical tenderness was present, as was lower abdominal voluntary guarding to palpation. Deeppalpation of the left lower quadrant did not elicit pain over the right lower quadrant (ie, negative Rovsing sign). Internal and external rotationof the flexed right legdidnotelicit pain (ie, negativeobturator sign).Dorsiflexionof the right thigh against the examiner’shandresulted in right lowerquadrantpain (ie,positivepsoas sign). Rectal examinationwas unrevealing. Levels of liver function enzymes, amylase, and bilirubin were normal, as was a complete blood cell count, except for leukocytosis of 14 000cells/mm.Urinalysiswas unremarkable. A computed tomography (CT) scan was obtained (Figure 1). L R A B C

DOI: 10.1001/jama.2013.276158

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@article{Bao2013AcuteAP, title={Acute abdominal pain and abnormal CT findings.}, author={Jean Bao and Jorge A Lopez and Sergio Huerta}, journal={JAMA}, year={2013}, volume={310 8}, pages={848-9} }