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Vomiting and abdominal pain in a woman with diabetes

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A CT scan of this patient’s abdomen led us to an unusual and life-threatening diagnosis.


 

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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).

WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU TREAT THIS PATIENT?

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