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JAMA Surgery Clinical Challenge
September 20, 2017

Acute Abdominal Pain in a Man in His 50s

Author Affiliations
  • 1Department of Hepatobiliary and Pancreatic Surgery, Henan Provincial People’s Hospital, Zhengzhou, China
  • 2Department of Vascular Surgery, Henan Provincial People’s Hospital, Zhengzhou, China
JAMA Surg. Published online September 20, 2017. doi:10.1001/jamasurg.2017.3441

A man in his 50s with a history of smoking and chronic hypertension was admitted to our hospital with a 36-hour history of upper abdominal pain, nausea, and vomiting. He had no history of previous surgery or trauma. His systolic blood pressure was 109 mm Hg, his diastolic blood pressure was 70 mm Hg, and his pulse rate was 100 beats/min. A physical examination revealed moderate epigastric tenderness with rebound and guarding. Laboratory test results were remarkable for a white blood cell count of 13 970/μL, hemoglobin level of 8.4 g/dL, serum creatinine level of 1.67 mg/dL, serum amylase level of 57 U/L (reference range, 30-110 U/L), and serum triglyceride level of 282.42 mg/dL, with no evidence of coagulopathy. (To convert the white blood cell count to ×109 per liter, multiply by 0.001; hemoglobin level to grams per liter, by 10; serum creatinine level to micromoles per liter, by 88.4; serum amylase level to microkatals per liter, by 0.0167; and serum triglyceride level to millimoles per liter, by 0.0113.) Contrast-enhanced computed tomography (CECT) and mesenteric angiography were performed (Figure 1).

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