Description
A 65-year-old woman with past medical history significant for Perinuclear Anti-Neutrophil Cytoplasmic Antibodies (p-ANCA) vasculitis, peripheral arterial disease requiring left femoral-popliteal bypass, chronic anaemia, hypertension, hyperlipidaemia and hyponatraemia secondary to SIADH, presented to the emergency department with 1-hour history of acute onset severe, diffusely crampy abdominal pain associated with nausea, vomiting and diarrhoea. The patient reported experiencing similar but less severe symptoms 4 days prior to presentation, with gradual resolution without treatment. Additionally, the patient was admitted 2 months prior with abdominal discomfort associated with nausea, vomiting and elevated liver enzymes and was found to have mild biliary ductal dilatation without evidence of acute cholecystitis.
On evaluation, the patient was only tachycardic to 105, but otherwise was haemodynamically stable and afebrile. Physical examination revealed a soft, mildly distended abdomen with diffuse, non-localised tenderness and no signs of peritonitis. Labs revealed elevated white cell count of 16.8 K/mm3 and an anion gap...
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