Abdominal Pain - Timely Diagnosis

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When a medical problem comes on quickly or occurs periodically over a longer period, it is often best to move quickly and make a diagnosis while symptoms are still present; the more serious the problem, the greater the urgency. Nevertheless, urgency should never replace careful and complete diagnostic testing, as is illustrated by a recent experience.

I was asked to see a patient, a young man in his late twenties, who for several years had been having episodes of abdominal pain. There was nothing very distinctive about the pain except that it would last from hours to one or two days and then disappear. During the episodes, he would not eat; he also noted some nausea. He had visited an emergency room once, but only limited testing had been done, and no diagnosis was made. At a later time, he had been seen by a gastroenterologist who had performed an upper gastrointestinal endoscopy. No abnormalities were found by endoscopy.

The patient was healthy except for the bouts of abdominal pain. Despite discussing his medical history in detail and examining him, I could find no clues to the cause of his problem. Since the episodes always resolved completely, I thought the best course of action would be to see him during an episode of pain. By examining the patient during an episode, I hoped to be able to decide on the best diagnostic course.

It took almost 12 months, but finally, early one morning I got a call from the patient. A typical episode of abdominal pain was beginning. I told him to have someone drive him to my office where I'd meet him. When we met, he was in severe pain, and his abdomen was very tender to the touch. I had not expected such severity and was a bit puzzled. Fortunately, I shared the office with a general surgeon who was used to dealing with abdominal emergencies. He also was impressed by the severity of the episode and recommended that the patient be sent to the emergency room. He was concerned that surgery might be required and also felt that diagnostic testing could be expedited from the emergency room.