[A rare differential diagnosis of acute abdominal pain--case 04/2009].
METHODS
A 44-year-old woman was referred to the emergency department for acute paraumbilical abdominal pain with colics. 5 days previously, a tooth extraction had been performed and postoperatively ibuprofen had been prescribed for pain relief. The medical history was empty besides a penicillin allergy and two caesarean sections 20 and 21 years ago.


METHODS
The physical examination revealed paraumbilical pain on palpation. Abdominal ultrasound could identify some free fluid and an aperistaltic intestinal loop as well as an echo-rich structure in the hypogastric region. An abdominal CT scan showed a hypodense tubular structure of 6.5 x 3.3 cm indicating a possible ischaemic intestinal segment, and a dilated intestinal loop as well as an uterus myomatosis. Due to therapy refractory symptoms and increasing leucocytes on the second day after admission, a diagnostic laparoscopy was performed.


METHODS
Intraoperatively, a volvulus of the ileum as well as an adhesive strangulation of the small intestine could be identified.


METHODS
Consecutively, surgery with an ileocoecal resection and a side-to-side ileotransversostomy was performed. Within a few days, the patient recovered completely and resumed normal activities of daily living.


CONCLUSIONS
In the evaluation of unclear acute abdominal pain, interdisciplinary cooperation is very important to ensure a fast and appropriate diagnosis and therapy as shown in our case.
Haap
Michael
M
Medizinische Universitätsklinik Tübingen, Abteilung für Endokrinologie, Diabetes, Nephrologie, Angiologie und Klinische Chemie, Tübingen, Germany.
Artunc
Ferruh
F
Haas
Christian S
CS
Horger
Marius
M
Teichmann
Reinhard
R
Riessen
Reimer
R
D000005:Abdomen / Q000000981:diagnostic imaging; D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D044684:Colon, Transverse / Q000601:surgery; D003125:Colostomy / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D007080:Ileocecal Valve / Q000601:surgery; D007081:Ileostomy / Q000379:methods; D045822:Intestinal Volvulus / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography