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JAMA Surgery Clinical Challenge
March 2016

Postprandial Abdominal Pain

Author Affiliations
  • 1Division of Vascular Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
  • 2Interventional Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
  • 3Jesse Brown, Veterans Affairs Medical Center, Chicago, Illinois
  • 4Editor, JAMA Surgery
JAMA Surg. 2016;151(3):287-288. doi:10.1001/jamasurg.2015.4715

An active man in his early 80s presented to the hospital with a 6-month history of cramping epigastric abdominal pain that occurred 30 minutes after eating solid food and was associated with nausea and vomiting. His medical history was significant for atrial fibrillation and a history of an open abdominal aortic aneurysm repair. Review of systems revealed a 9-kg weight loss. A recent esophagogastroduodenoscopy was unremarkable, but prior colonoscopy showed focal colitis that was treated with antibiotics. Physical examination revealed he was in sinus rhythm. He had no abdominal tenderness but had an abdominal bruit. Laboratory examination results were unremarkable. Mesenteric duplex ultrasonography showed the following: celiac artery velocity of 394 cm/s on inspiration (Figure, A) and 608 cm/s on expiration (Figure, B), superior mesenteric artery (SMA) velocity of 380 cm/s, and an occluded inferior mesenteric artery. Subsequent angiography corroborated findings.

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