Ambiguous Anatomy and Its Pain

Abstract

Question: A 46-year-old woman presented to the emergency department with a 1-day history of sudden onset colicky central abdominal pain. She had been passing flatus until that morning and her last bowel motion was the day before. She had been tolerating diet without any nausea or vomiting. She had no significant medical history and had otherwise been previously fit and well throughout her life. She had no previous surgery and no previous endoscopic procedures. She was an active smoker. Her vital signs were normal on surgical review. Initially she appeared comfortable however on serial observations she appeared to develop waves of colicky and severe cramping pain. There was no abdominal distension noted. Her abdomen was generally tender maximally in the epigastrium with localized guarding. Her white cell count was 12.9 × 109/L and her C-reactive protein was 2.0 mg/L. Her serum electrolytes, renal function, liver function tests, and lipase were all normal.