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JAMA Surgery Clinical Challenge
October 18, 2017

Progressive Acute Abdominal Pain

Author Affiliations
  • 1Department of Surgery, State University of New York University Hospital of Brooklyn
  • 2Department of Surgery, Kings County Medical Center, Brooklyn, New York
JAMA Surg. Published online October 18, 2017. doi:10.1001/jamasurg.2017.3838

A woman in her 50s with a history of systemic lupus erythematosus, congestive heart failure, and type 2 diabetes presented to the emergency department with worsening abdominal pain 1 day after discharge from an admission for similar abdominal pain. The patient described a 4-day history of progressively worsening abdominal pain and diarrhea and denied fevers, chills, diaphoresis, or any previous similar episodes. Her abdomen was distended and mildly tender, and her pain was disproportionate to the findings of her physical examination. There were no abnormal laboratory test findings. The abdominal computed tomography (CT) scan from her initial admission (Figure, A) and the abdominal CT angiogram on readmission (Figure, B) showed dramatic progression of her disease.

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