CASE 43: ABDOMINAL DISCOMFORT
History
A 64-year-old woman is referred to outpatients with a 6-month history of mild abdominal
discomfort. This has been intermittent and involved the right iliac fossa mainly. There has
been no particular relation to eating or to bowel movements. Over this time her appetite
has gone down a little and she thinks that she has lost around 5 kg in weight. The intensity
of the pain has become slightly worse over this time and it is now present on most days.
Over the last 6 weeks she has developed some new symptoms. She has developed a dif-
ferent sort of cramping abdominal pain located mainly in the right iliac fossa. This pain
has been associated with a feeling of the need to pass her motions and often with some
diarrhoea. During these episodes her husband has commented that she looked red in the
face but she has associated this with the abdominal discomfort and the embarrassment
from the urgent need to have her bowels open.
There is no other relevant previous medical history. She has smoked 15 cigarettes daily for
the last 45 years and she drinks around 7 units of alcohol each week. She has noticed a little
breathlessness on occasions over the last few months and has heard herself wheeze on sev-
eral occasions. She has never had any problems with asthma and there is no family history
of asthma or other atopic conditions.
She worked as a school secretary for 30 years and has never been involved in a job involv-
ing any industrial exposure. She has no pets. She has lived all her life in London and her
only trip outside the UK was a day trip to France.
A computed tomography (CT) scan of her abdomen was performed and is shown in
Fig. 43.1.INVESTIGATIONS
Figure 43.1Computed tomography scan of
the abdomen.Questions
- What diagnoses should be considered?
- What investigations should be performed?