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JAMA Surgery Clinical Challenge
August 2016

An Older Female Patient With Abdominal Distention

Author Affiliations
  • 1Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
JAMA Surg. 2016;151(8):773-774. doi:10.1001/jamasurg.2016.0240

An 84-year-old woman presented to the emergency department with 2 days of progressive abdominal distention and nausea. She also had anorexia, and she had crampy abdominal pain during the past few days. Similar symptoms occurred previously but were self-relieved. In triage, her body temperature was 37.3°C, and she had a normal heart rate. Physical examinations were notable for distended abdomen and hyperactive bowel sounds but negative for the peritoneal sign. She reported dull pain below the pelvic bone as we palpated gently over the abdomen. No gross abnormalities were present in the perineal area. Her medical history was unremarkable, except for hypertension, and she denied having any abdominal operations.