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JAMA Surgery Clinical Challenge
December 2014

Colicky Epigastric and Right Upper Quadrant Pain

Author Affiliations
  • 1Department of Surgery, University Hospital Freiburg, Freiburg im Breisgau, Germany
  • 2Department of Radiology, University Hospital Freiburg, Freiburg im Breisgau, Germany
JAMA Surg. 2014;149(12):1337-1338. doi:10.1001/jamasurg.2014.316

A woman in her 50s presented to our emergency department with a 3-hour history of sudden epigastric and right upper quadrant pain. She did not report any previous abdominal surgery. The colicky pain did not migrate during that period and occurred in paroxysms at 9- to 10-minute intervals. The patient was afebrile and had no nausea or vomiting. Physical examination revealed mild tachycardia (96/min) and moderate abdominal distension without signs of peritonism; the bowel sounds were hyperactive. Careful examination ruled out incarcerated hernias in the groin, femoral triangle, and obturator foramen. Blood analysis results showed mild leukocytosis (total white blood cell count, 10.5 × 103/μL [to convert to ×109 per liter, multiply by 0.001]) without elevation of the C-reactive protein level (<3 mg/L [to convert to nanomoles per liter, multiply by 9.524]). Serum electrolyte levels were within the normal range. Computed tomography of the abdomen was conducted (Figure).

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