The 53rd meeting: "An Unusual Case of Abdominal Pain"


Ciao, this is Hakodate Ryouhoku Hospital.
I'm Dr. Daisy.
Today we present an abstract of the CLINICAL PROBLEM-SOLVING article, “An Unusual Case of Abdominal Pain".
A 41-year-old man presented to the emergency department with abdominal pain. The pain was excruciating and sudden in onset, originating in his right lower quadrant and radiating to his right groin and flank. It was slightly reduced when he was lying down but was otherwise unaffected by position. He reported nausea and one episode of nonbloody, nonbilious emesis shortly after the onset of the pain.
The initial evaluation of a patient with acute abdominal pain should focus on identifying life-threatening causes and surgical emergencies such as cholecystitis, aortic dissection, mesenteric ischemia, and bowel perforation. Although in this case the location of the pain should prompt consideration of appendicitis, the sudden onset suggests an acute event, which could be relatively benign or more ominous. This presentation would be atypical for cholecystitis, but I would not rule out this possibility, given that cholecystitis is a common cause of abdominal pain.
Given the protean manifestations of the vasculitides, they should be considered in the differential diagnosis of a range of clinical presentations. In this patient, the finding of infarcts in both kidneys, along with laboratory evidence of marked inflammation, led to renal angiography, which showed evidence of numerous microaneurysms characteristic of polyarteritis nodosa.
The diagnosis is made on the basis of a constellation of typical symptoms, supportive laboratory tests, and either a biopsy of the affected tissue showing characteristic necrotizing arterial inflammation or visceral angiography showing microaneurysms in the renal, mesenteric, or hepatic vasculature.
The prognosis for patients with untreated polyarteritis nodosa is grim, with a 5-year survival rate of 13%; death is often a consequence of renal failure, myocardial infarction, or stroke. With appropriate therapy, the 5-year survival rate is approximately 80%. Given the poor prognosis associated with untreated polyarteritis nodosa and the substantial improvement with appropriate treatment, it is important to consider this condition early in the differential diagnosis in order to minimize morbidity and the risk of death.

Thank you for listening, ciao.

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