 A 23-year-old Turkish female presents to the emergency department for evaluation of acute abdominal
A 23-year-old Turkish female presents to the emergency department for evaluation of acute abdominal pain.
She reports that she has had multiple episodss of sever abdominal pain since age 15. These episods have been very sever, once promoting exploratory laparatomy at age 18 with removal of appendex, which histologically benign. She reports that pain lasts aproximatelly 2 or 3 days and then resolves entirely without intervention. There are no cleare triggers for the pain. Past evaluation has included normal upper and lower endoscopy, normal small bowel series, multiple CT scans that have shows only small amounts of free fluid in the abdominal cavity. In addition, the patient racently developed a migratory arthritis affecting her Knees and ankels. THe patient currently on no medications. Multiple family members have similar complain.
ON physical examination,patient appears in moderate distress, lying very stil. Temprerature is 39.8 C. Heart rate is 130, and blood pressure is 112/66. She has evidence of pleural effusion on the right with decreased breath sounds and dullness to percussion of half the lung feild. She has regular tachycardia without murmurs. Bowel sounds are hypoactive, and there is moderate diffuse abdominal tederness. the is mild rebound tenderness diffusely throughout abdomen without guarding. Her left knee is swallen and reythematuos with an effusion.
Laparatory studies show a white blood cell count of 15,300/mm3 with 90% neutrophils. ESR is 110 s. arthrocentesis reveals WBC count 68,000 with 98% neutrophils. Cultuer is negative at a week.
The patient's symptoms resolves over the course osf 72 h.
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12-26-2007, 08:48 PM
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