An Unusual Cause of Abdominal Pain

Abstract

A 32-year-old female presented to the emergency department with severe, unrelenting pain in her abdomen for two days accompanied by vomiting and gross abdominal distension. She had no history suggestive of gastric outlet obstruction, and signs of peritoneal irritation were absent. On examination, the patient was hemodynamically unstable. On palpation, the abdomen had a diffuse tympanitic note, and the Pouch of Douglas was distended, but tenderness was absent. An intravenous line was started immediately and after resuscitation investigations showed an arterial pH of 7.32, K+ = 2.7 mEq/L, and Na+ = 123 mEq/L with a leukocyte count of 16 500. A nasogastric tube was inserted, and about 100 cm3 of greyish semisolid fluid returned. A supine abdominal X-ray was done. The patient soon developed massive hematemesis and rapidly progressed to shock from which she could not be revived.

Subject