title: Abdominal pain and faeculent vomiting in a 64-year-old woman.
abstract: A 64-year-old woman with a previous right colectomy presented with severe epigastric abdominal pain and nausea of several weeks' duration, which then escalated to projectile faeculent emesis. During her clinical course, she remained afebrile with normal vital signs. Physical examination revealed abdominal distension, moderate tenderness in the bilateral upper quadrants and provoked voluntary abdominal wall guarding. Haematology and laboratory chemistries were only notable for a mild (14.6 K/μL) leucocytosis. Acute abdominal plain radiological series revealed dilated small bowel loops and possible pneumoperitoneum. Abdominal CT demonstrated a mechanical small bowel obstruction and no extraluminal air. An exploratory laparotomy was performed, revealing an obstructing enterolith related to actively inflamed jejunal diverticulitis (complicated JD). This case report aims to describe the non-specific presentation of a poorly understood disease entity that presents a diagnostic and therapeutic challenge for the medical community.
authors.affiliation: University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Leigha
authors.initials: L
authors.lastname: Winters
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Krell
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: David
authors.initials: D
authors.lastname: Machado-Aranda
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D003082:Colectomy; D004238:Diverticulitis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000601:surgery; D007579:Jejunal Diseases / Q000150:complications / Q000175:diagnosis*; D007813:Laparotomy; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014839:Vomiting / Q000209:etiology*