advertisement
Updated 03 July 2015

What's your diagnosis? - Case 14: abdominal pain and swelling

Mr A presents to his GP, complaining of severe abdominal pain. In this week’s case, we give you a case history and insight into his special investigations. See if you can figure out what’s ailing Mr A.

0

Mr A, a 45 year old attorney, is suffering from severe abdominal pain. Two years ago he had similar pain, which turned out to be a peptic ulcer that perforated the stomach lining. He underwent emergency surgery to repair the ulcer, and never had any recurring symptoms. 

The following is a summary of the GP’s notes:

History

Presents with one-day history of cramp-like abdominal pain.
Not confined to a specific area on the abdomen.

Progressively worsening “swelling” of the abdomen

Nausea and vomiting for past 6 hours

Unable to pass any stool or wind (flatus)

Previous peptic ulcer disease. Taking omeprazole daily.

Previous surgery: perforated peptic ulcer repair (2 years ago)

On Examination

General examination:
Mr A is in significant pain – he appears restless, sweating and is complaining of severe stomach cramping.

Abdominal examination:

Abdomen appears distended. Midline scar from previous surgery visible.

On palpitation:

Abdomen feels hard, very tender in all areas
No bowel sounds audible on auscultation

Rectal examination:

Faeces on glove.  No blood noted.

Side Room Investigations


Heart rate: 108
Respiratory rate: 19
Urine dipsticks: clear

Special investigation

The GP decides to do an abdominal X-ray. This is the resulting image:

abdominal x-ray showing pathology

Based on the clinical information and the special investigations, what is your diagnosis?

Clues:

1.  The history and the examination should provide you with enough information to make a provisional diagnosis.
2.  On the X-ray, look for repetitive patterns to support your diagnosis made from the history.

What’s your diagnosis? Join the guesswork on our Facebook page, or comment below. 

NOTE: Health24's on-site GP Dr Owen Wiese will reveal new cases on Thursdays. We'll post the answer with the story on Mondays, or you can get it via the Daily Tip – sign up here.

Previously on What's Your Diagnosis

What's your diagnosis? -  Case 1: vomiting and weight loss
What's your diagnosis? -  Case 2: eye pain
What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back
What's your diagnosis? -  Case 4: seeing odd things
What's your diagnosis? - Case 5: mysterious lungs
What's your diagnosis? - Case 6: runner with seizures
What's your diagnosis? - Case 7: swollen knee
What's your diagnosis? - Case 8: bloody semen
What's your diagnosis? - Case 9: confusing neurological signs
What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms
What's your diagnosis? - Case 11: bruising with no apparent reason
What's your diagnosis? - Case 12: severe tummy pain
What's your diagnosis? - Case 13: severe sore throat

Image: Abdominal X-ray showing pathology from By James Heilman, MD (Own work) [CC BY-SA 3.0 or GFDL], via Wikimedia Commons

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.

 
NEXT ON HEALTH24X
advertisement

Read Health24’s Comments Policy

Comment on this story
0 comments
Comments have been closed for this article.

Live healthier

The debate continues »

Working out in the concrete jungle 7 top butt exercises for guys 10 things pole dancing can do for you

The running vs. walking debate

There are many different theories when it comes to the running vs. walking for health and weight loss.

Veganism a crime? »

Running the Comrades Marathon on a vegan diet Are vegans unnatural beasts? Can a vegan be really healthy?

Should it be a crime to raise a baby on vegan food?

After a number of cases of malnourishment in Italy, it may become a crime to feed children under 16 a vegan diet.