A 60-year-old woman with diabetes sought treatment for worsening generalized abdominal pain and intermittent vomiting that she’d had for 5 days. She was afebrile and had no history of abdominal surgeries.
Liver function and amylase tests were normal. Lab work revealed normal sodium and potassium levels and a normal platelet count. The patient’s hemoglobin was 12.2 g/dL (normal 12.3-15.3 g/dL); white blood cell count, 150,000 mcL (normal 4500-11,000 mcL); serum blood urea nitrogen, 25 mg/dL (normal 6-20 mg/dL); serum creatinine, 1.3 mg/dL (normal 0.6-1.2 mg/dL); and blood glucose, 331 mg/dL (normal <125 mg/dL).
On physical examination, the patient had moderate abdominal distension without tenderness. Murphy’s sign was negative. A digital rectal examination revealed an empty rectum. The patient was hospitalized for further work-up and a computed tomography (CT) scan of the abdomen was performed (FIGURE 1).