CASO CLÍNICO - REUNIÓN 24/10/2008
A 23-year-old black woman presented to the emergency department with diffuse, colicky abdominal pain of 1 hour’s duration.
The pain was followed by nausea and episodes of bilious vomiting and did not radiate or change with the patient’s position. She did not report fever, chills, diarrhea, hematochezia, or melena.
On examination, the patient was afebrile, with a heart rate of 100 beats per minute, a respiratory rate of 16 breaths per minute, an oxygen saturation of 100% while she was breathing ambient air, and a blood pressure of 115/65 mm Hg. Her height was 65 in. (165.1 cm), and she weighed 115 lb (52.3 kg).
She was restless on the gurney, clutching her abdomen. Her sclerae were anicteric, and her conjunctivae were pale. The oropharynx was normal, and the neck was supple, without lymphadenopathy. The heart sounds were regular, and the lungs clear.
There was no chestwall or flank tenderness. Abdominal examination revealed hyperactive bowel sounds and diffuse tenderness on palpation without rebound tenderness, organomegaly, or masses. The rectal examination showed no masses. A stool sample was brown and was negative for occult blood. The pelvic examination revealed no masses, cervical motion, or adnexal tenderness. There was no edema in the legs. The neurologic examination was normal.
The patient reported that a similar episode had occurred 6 months previously. It lasted 30 minutes and resolved on its own. At that time, she passed red blood from the rectum once but did not seek medical attention. Her other medical history included an elective abortion at 20 years of age and anemia and metromenorrhagia, neither of which had been further evaluated. She had no history of abdominal surgeries. She said that she did not use tobacco, alcohol, or illicit drugs, and she worked as a legal assistant. She was unaware of any gastrointestinal or sickle cell disease in her family.
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