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JAMA Surgery Clinical Challenge
December 2016

Acute Upper Abdominal Pain With a Distended Cecum in the Left Upper Quadrant

Author Affiliations
  • 1Department of Surgery, Beth Israel Deaconess Hospital–Plymouth, Plymouth, Massachusetts
  • 2Department of Radiology, Beth Israel Deaconess Hospital–Plymouth, Plymouth, Massachusetts
JAMA Surg. 2016;151(12):1179-1180. doi:10.1001/jamasurg.2016.3185

A woman in her 60s presented with acute-onset, diffuse abdominal pain for 24 hours accompanied by nausea and retching. She had no significant medical history and no prior abdominal surgery. In the emergency department, she was afebrile with stable vital signs. Results of her abdominal examination revealed a slight distension and diffuse tenderness to palpation, particularly in the epigastrium and right upper quadrant, but no peritoneal signs. Results of laboratory tests were unremarkable except for mild leukocytosis. Abdominopelvic computed tomography revealed a distended cecum in the left upper quadrant (Figure 1).

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