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JAMA Surgery Clinical Challenge

Lower Abdominal Pain With Nausea and Vomiting

Image of Figure 1

Figure. A, Abdominal computed tomography suggesting the presence of an ileal intussusception. B, Colonoscopy revealing the presence of a bulge in the cecal lumen.

Valentino Fiscon, MD
Giuseppe Portale, MD
Paola Cusatelli, MD

A woman in her 40s presented to our department with lower abdominal pain, lasting for a few weeks, with nausea and vomiting but no diarrhea or fever. Her medical history was unremarkable; in particular, she had no history of endometriosis. She had visited the emergency department of another hospital 2 weeks before with the same symptoms and had received conservative treatment. On physical examination in the present visit, she had lower abdominal tenderness but no sign of peritoneal irritation. A mass was palpable in the lower right abdominal quadrant. The results of routine blood investigations, including white blood cell count, hemoglobin concentration, and C-reactive protein level, were within normal limits, as they had been in the previous hospital. Abdominal ultrasonographic examination was performed, followed by abdominal computed tomography; the results were suggestive of an ileal intussusception (Figure, A). A colonoscopy revealed the presence of a bulge in the cecal lumen (Figure, B).

See the full article for an explanation and discussion.

Author Affiliations: Fiscon and Portale (portale@surgery.usc.edu) are affiliated with the Department of General Surgery, Azienda Unità Locale Socio Sanitaria 15, Alta Padovana, Cittadella, Padova, Italy, and Cusatelli is affiliated with the Department of Pathology, Azienda Unità Locale Socio Sanitaria 15, Alta Padovana, Cittadella, Padova, Italy.