Endocrine Case Report: Lower Left Quadrant Pain


This endocrine case report from Brady Pregerson, MD, features a man in his 60s with diabetes mellitus presenting with 5 days of nonradiating intermittent lower abdominal pain. Can you determine the correct diagnosis?

History of Present Illness:

A man in his 60s with a history of diabetes mellitus, hypertension, and COPD presents to the emergency department for 5 days of nonradiating intermittent lower abdominal pain that is a bit worse on the left and 2 days of intermittent vomiting. Both the pain and the vomiting got worse today. He doesn’t recall when his last bowel movement was but states he usually only goes every 2-3 days. He denies any fever, bleeding, diarrhea, melena or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for moderately elevated BP. The abdomen is tender in both lower quadrants without guarding.

Initial Diagnostic Testing:

Blood: CBC had white blood count (WBC) of 13.6 and hemoglobin of 11.1. BMP normal except glucose 156 and bicarb 20 but no anion gap. LFT/lipase normal.

Urine: 10-20 RBC, 0-5 WBC, no bacteria


CT Scan of a patient's abdomen | Credit: Brady Pregerson, MD

What is the diagnosis?

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