Radiology: Volume 253: Number 2-November 2009
Jesse Courtier, Kamran Ali, MD
A 21-year-old man presented to the emergency department with a history of acute upper abdominal pain, nausea, and vomiting. He received a presumptive diagnosis of and treatment for gastroenteritis and was released. He returned to the emergency department later that same day with worsening upper abdominal pain and vomiting. He was afebrile. His vital signs were within normal limits. Physical examination revealed abdominal distention, upper abdominal tenderness, and both voluntary and involuntary guarding. There was no rebound tenderness. Examination of the skin revealed no rashes or petechiae. Physical examination findings were otherwise unremarkable. Review of the patient's history revealed several other emergency department visits and hospital admissions for similar episodes of abdominal pain in the past 3 years. His family history was remarkable for similar episodes of recurrent abdominal pain in his father. The only medication he was taking was oral danazol (200 mg) twice per day. He had no history of recent travel outside the United States or of an immunocompromised state. Laboratory tests performed at the second admission revealed a white blood cell count of 11.2 X 109/L (normal range, 4.5-10.8 X 109/L); otherwise, the results were unremarkable. To further evaluate this patient's abdominal pain, intravenous contrast material-enhanced multidetector computed tomography (CT) of the abdomen and pelvis was performed with injection of 100 mL of iohexol (Omnipaque 300; GE Healthcare, Milwaukee, Wis) administered at a rate of 3 mL/sec.