A 75 year old female is brought in by her daughter for epigastric pain.
Symptoms were gradual in onset over the last 2 days. She endorses intermittent 8/10 achy discomfort, radiating from her stomach to her lower abdomen. Worse with meals. No associated nausea or vomiting. Last bowel movement was 3 days ago.
She drinks fiber powder regularly but denies a history of constipation. Her family gave her dulcolax last night.
On review of systems she has no chills, chest pain, shortness of breath, or dysuria. Her only medical history is hypertension. Surgical history includes hysterectomy and bladder repair.
On exam her abdomen is soft, mildly tender to palpation over the epigastrium, no rebound or guarding.
An acute abdominal series was obtained and read as fecal impaction of the cecum and ascending colon without evidence of obstruction.
A CT abdomen/pelvis with IV contrast was obtained and shown below:
What is the diagnosis?
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The diagnosis for this case will be posted in approximately 1 week.
Some fluid and fat stranding inferior to the liver, and the pancreas doesn't look quite right. Pancreatitis? Intraabdominal abscess with associated ileum?
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