A number of the comments in this letter, while appropriate to the questions of abdominal pain and diarrhea among runners, miss the particular points of interest in this patient. In the first place, there are no complaints of diarrhea in her history, and, thus, the possibilities of lactase deficiency, parasympathetic "tone," and intestinal infestation are not really relevant. Second, episodes of bleeding have not, to my knowledge, been duplicated among other runners. It is this occurrence that makes me suspect the presence of a structural lesion of the bowel, symptoms from which may well have been precipitated by her exertions. Finally, in regard to Meckel's diverticula, it is important to recognize that as many as 45% of symptomatic patients are older than 21 years when their illness first manifests itself.1,2
Dworken HJ. Abdominal Pain in a Runner-Reply. JAMA. 1983;250(8):1027. doi:10.1001/jama.1983.03340080017015
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