Not Simply an Ulcer
Not Simply an Ulcer
A 67-year-old woman experienced a sudden onset of right lower abdominal pain without other associated symptoms
• A 67-year-old woman experienced a sudden onset of right lower abdominal pain without other associated symptoms
She contacted her physician who did not identify a clear etiology and referred her to a surgeon
• She contacted her physician who did not identify a clear etiology and referred her to a surgeon
The physical examination,laboratory tests and a CT scan did not demonstrate obvious abnormalities
• The physical examination, laboratory tests and a CT scan did not demonstrate obvious abnormalities
The patient underwent a laparoscopy with incidental appendectomy.Her abdominal pain subsided and she returned to work
• The patient underwent a laparoscopy with incidental appendectomy. Her abdominal pain subsided and she returned to work
One week later,she developed bilateral leg pain. She described the pain as "pins and needles" that often started when she was sitting or lying down and occasionally improved when she walked slowly.She underwent a non-invasive work up of her peripheral vasculature demonstrated slightly decreased flow through the left iliac artery. She received symptomatic therapy with naproxen and propoxyphene
One week later, she developed bilateral leg pain. She described the pain as "pins and needles" that often started when she was sitting or lying down and occasionally improved when she walked slowly. She underwent a non-invasive work up of her peripheral vasculature demonstrated slightly decreased flow through the left iliac artery. She received symptomatic therapy with naproxen and propoxyphene
One month later,she developed intense mid- abdominal pain,nausea and low-grade fever. She again contacted her local physician who admitted her because of partial small bowel obstruction with the diagnosis of diverticulitis. She improved gradually with conservative management and was discharged. Soon after discharge,she developed bilateral leg swelling and persistent fatigue. After additional two weeks,she presented for further evaluation
One month later, she developed intense midabdominal pain, nausea and low-grade fever. She again contacted her local physician who admitted her because of partial small bowel obstruction with the diagnosis of diverticulitis. She improved gradually with conservative management and was discharged. Soon after discharge, she developed bilateral leg swelling and persistent fatigue. After additional two weeks, she presented for further evaluation
prior medical history Her prior medical history was remarkable for recurrent bronchopulmonary problems that had been attributed to her long smoking history
prior medical history Her prior medical history was remarkable for recurrent bronchopulmonary problems that had been attributed to her long smoking history
physical examination On physical examination she was thin,but not emaciated. There was no peripheral lymphadenopathy. Bilateral wheezing became prominent during forced expiration. The abdominal exam revealed slight tenderness without guarding or rebound. There was a large mass in the mid-abdomen and right flank,measuring about 10 cm. Normal bowel sounds were present.She had bilateral pitting edema up to the knees
physical examination • On physical examination she was thin, but not emaciated. • There was no peripheral lymphadenopathy. • Bilateral wheezing became prominent during forced expiration. • The abdominal exam revealed slight tenderness without guarding or rebound. • There was a large mass in the mid-abdomen and right flank, measuring about 10 cm. • Normal bowel sounds were present. She had bilateral pitting edema up to the knees
The pedal pulses were palpable and strong 。Active mobility,. reflexes and epicritic sensory testing were normal
• The pedal pulses were palpable and strong. • Active mobility, • reflexes and epicritic sensory testing were normal
