A 57-year-old woman presented to the emergency department with a 1-day history of upper abdominal pain. The pain was localized to the epigastrium and had acute onset that prevented her from working for the rest of the day. There was no association between the pain and eating. No history of nausea, vomiting, diarrhea, melena, hematochezia, constipation, or fevers was reported. She had no alcohol abuse or smoking history. Dyslipidemia and a transient ischemic attack 3 years before were her only medical history. She had never had a colonoscopy or a gastroscopy. Her medication included atorvastatin and acetylsalicylic acid. The only past operation she reported was for treating carpal tunnel syndrome. She was a sheep breeder and was in close contact with animals for 8 to 12 hours every day.
Mitrousias V, Alexiou E, Giaglaras A. A Woman With Abdominal Pain and Anemia. JAMA Surg. 2016;151(7):673-674. doi:10.1001/jamasurg.2016.0246