RT Journal
A1 McKee TI
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD February 1
VO 147
IS 2
SP 195
OP 195
DO 10.1001/archsurg.2011.642
UL http://dx.doi.org/10.1001/archsurg.2011.642
AB 
A 71-year-old woman had a sudden onset of what she described as a “tummy ache” at 9 PM the evening prior to admission to the hospital. The midabdominal discomfort progressively worsened to severe abdominal pain with associated back pain. She had vomiting without hematemesis. There was no history of hematochezia or melena, and she had a normal bowel movement the previous day. She was receiving treatment with warfarin sodium for a history of atrial fibrillation. Formerly weighing 144.0 kg, she attributed a weight loss of 60.8 kg over 8 years to exercise and a diet plan that included a lot of fiber. Although she had diverticulosis noted on a colonoscopy a few years ago, she had never had an abdominal operation. Her family history included coronary artery disease and cerebrovascular accident.