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JAMA Surgery Clinical Challenge
September 2014

Abrupt Vomiting and Pain With Abdominal Mass

Author Affiliations
  • 1Department of Surgery, Sodegaura Satsukidai Hospital, Sodegaura, Chiba, Japan
  • 2Surgical Center, University of Tokyo, Bunkyo-ku, Tokyo, Japan
JAMA Surg. 2014;149(9):987-988. doi:10.1001/jamasurg.2013.3990

A 90-year-old woman presented with vomiting and acute abdominal pain that started 24 hours earlier. Her medical history included a partial oophorectomy of a right ovarian cyst, hypertension, and vomiting and abdominal pain once a year that started 10 years earlier. She had always been diagnosed as having adhesive ileus, and her symptoms always improved within a day after hospital admission. A physical examination at admission revealed that her abdomen was slightly distended and tender to palpation on the right side of the paraumbilical point without muscle guarding. The hematologic findings revealed slight anemia and amylasemia; her hemoglobin level was 9.3 g/dL (to convert to grams per liter, multiply by 10.0), and her amylase level was 168 U/L (to convert to microkatals per liter, multiply by 0.0167). Abdominal computed tomography (CT) with intravenous contrast agent revealed a mass on the right side of the paraumbilical point (Figure 1).

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