An interesting cause of abdominal pain in the emergency room

Öz

Abstract Introduction: In this case report, we aimed to present a case of abdominal pain who presented to the emergency department with complaints of abdominal pain and constipation for 2 days. Case report: A 76-year-old woman presented to our emergency department with complaints of abdominal pain and constipation for 2 days. Physical examination revealed a distended abdomen, diffuse tenderness and hypoactive bowel sounds. Abdominal plain abdominal radiography showed approximately 10-12 similarly shaped hyperdense foreign bodies (long dimension measured 15 mm and short dimension measured 5 mm) in the left lower quadrant and left upper quadrant. Abdominal computed tomography showed similarly shaped nodular foreign bodies with dense calcific-metallic characteristic foreign bodies with different locations and contents, one in the stomach and the others in the colon. The next day, black stools were added to her complaints. Endoscopy and colonoscopy performed 3 days later revealed no nodular foreign body with calcific-metallic appearance. The patient was followed up by the gastroenterology department and discharged after her general condition improved. Conclusion: It should be kept in mind that atypical eating disorders may underlie high-density calcific-metallic nodular lesions in the stomach and intestines in patients presenting with abdominal pain. References 1. Kacprzyk A, Stefura T, Chłopaś K, Trzeciak K, Załustowicz A, Rubinkiewicz M, et al. Analysis of readmissions to the emergency department among patients presenting with abdominal pain. BMC Emerg Med. 2020;20(1):37. 2. Watkins JW 4th, Lewis ZB. Diagnoses of Exclusion in the Workup of Abdominal Complaints. Emerg Med Clin North Am. 2021 Nov;39(4):851-863. 3. Lameris W, van Randen A, Dijkgraaf MG, Bossuyt PM, Stoker J, Boermeester MA. Optimization of diagnostic imaging use in patients with acute abdominal pain OPTIMA: Design and rationale. BMC Emerg Med 2007;7:9. 4. Loo JT, Duddalwar V, Chen FK, Tejura T, Lekht I, Gulati M. Abdominal radiograph pearls and pitfalls for the emergency department radiologist: a pictorial review. Abdom Radiol (NY) 2017;42(4):987-1019. 5. Scheinfeld MH, Mahadevia S, Stein EG, Freeman K, Rozenblit AM. Can lab data be used to reduce abdominal computed tomography (CT) usage in young adults presenting to the emergency department with nontraumatic abdominal pain?. Emerg Radiol 2010;17:353–60. 6. Hardwick RH, Armstrong CP. Synchronous upper and lower gastrointestinal endoscopy is an effective method of investigating iron-deficiency anaemia. Br J Surg 1997;84:1725-8. 7. Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet 2020;395(10227):899-911. 8. Delaney CB, Eddy KT, Hartmann AS, Becker AE, Murray HB, Thomas JJ. Pica and rumination behavior among individuals seeking treatment for eating disorders or obesity. Int J Eat Disord 2015;48(2):238-48. 9. Lam CL, Pan PC, Chan AW, Chan SY, Munro C. Can the Hospital Anxiety and Depression (HAD) Scale be used on Chinese elderly in general practice?. Fam Pract 1995;12(2):149-54. 10. Ariza-Fernández JL, Úbeda-Muñoz M, Redondo-Cerezo E. Endoscopic retrieval of multiple large sharp foreign bodies from the stomach. Testing the limits of endoscopy. Gastroenterol Hepatol 2017;40(2):95-6.

Anahtar Kelimeler

• Abdominal pain
• constipation
• radiology
• eating disorders

Acil serviste karın ağrısının ilginç bir nedeni

Öz

Özet Giriş: Bu olgu sunumunda, acil servise 2 gündür karın ağrısı ve kabızlık şikayetiyle başvuran bir karın ağrısı olgusunu sunmayı amaçladık. Olgu sunumu: 76 yaşında bir kadın hasta, 2 gündür karın ağrısı ve kabızlık şikayetiyle acil servisimize başvurdu. Fizik muayenede karın şişkinliği, yaygın hassasiyet ve hipoaktif bağırsak sesleri görüldü. Abdominal düz karın radyografisinde sol alt kadranda ve sol üst kadranda yaklaşık 10-12 adet benzer şekilli hiperdense yabancı cisim (uzun boyutu 15 mm, kısa boyutu 5 mm ölçüldü) görüldü. Abdominal bilgisayarlı tomografide, biri midede, diğerleri kolonda olmak üzere farklı yerleşim ve içeriklere sahip yoğun kalsifik-metalik karakterli benzer şekilli nodüler yabancı cisimler görüldü. Ertesi gün şikayetlerine siyah dışkılama da eklendi. 3 gün sonra yapılan endoskopi ve kolonoskopide kalsifik-metalik görünümlü nodüler yabancı cisim görülmedi. Hasta gastroenteroloji bölümü tarafından takip edildi ve genel durumu düzeldikten sonra taburcu edildi. Sonuç: Karın ağrısı ile başvuran hastalarda mide ve bağırsaklarda yüksek yoğunluklu kalsifik metalik nodüler lezyonların altında atipik yeme bozukluklarının yatabileceği akılda tutulmalıdır. Kaynaklar 1. Kacprzyk A, Stefura T, Chłopaś K, Trzeciak K, Załustowicz A, Rubinkiewicz M, et al. Analysis of readmissions to the emergency department among patients presenting with abdominal pain. BMC Emerg Med. 2020;20(1):37. 2. Watkins JW 4th, Lewis ZB. Diagnoses of Exclusion in the Workup of Abdominal Complaints. Emerg Med Clin North Am. 2021 Nov;39(4):851-863. 3. Lameris W, van Randen A, Dijkgraaf MG, Bossuyt PM, Stoker J, Boermeester MA. Optimization of diagnostic imaging use in patients with acute abdominal pain OPTIMA: Design and rationale. BMC Emerg Med 2007;7:9. 4. Loo JT, Duddalwar V, Chen FK, Tejura T, Lekht I, Gulati M. Abdominal radiograph pearls and pitfalls for the emergency department radiologist: a pictorial review. Abdom Radiol (NY) 2017;42(4):987-1019. 5. Scheinfeld MH, Mahadevia S, Stein EG, Freeman K, Rozenblit AM. Can lab data be used to reduce abdominal computed tomography (CT) usage in young adults presenting to the emergency department with nontraumatic abdominal pain?. Emerg Radiol 2010;17:353–60. 6. Hardwick RH, Armstrong CP. Synchronous upper and lower gastrointestinal endoscopy is an effective method of investigating iron-deficiency anaemia. Br J Surg 1997;84:1725-8. 7. Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet 2020;395(10227):899-911. 8. Delaney CB, Eddy KT, Hartmann AS, Becker AE, Murray HB, Thomas JJ. Pica and rumination behavior among individuals seeking treatment for eating disorders or obesity. Int J Eat Disord 2015;48(2):238-48. 9. Lam CL, Pan PC, Chan AW, Chan SY, Munro C. Can the Hospital Anxiety and Depression (HAD) Scale be used on Chinese elderly in general practice?. Fam Pract 1995;12(2):149-54. 10. Ariza-Fernández JL, Úbeda-Muñoz M, Redondo-Cerezo E. Endoscopic retrieval of multiple large sharp foreign bodies from the stomach. Testing the limits of endoscopy. Gastroenterol Hepatol 2017;40(2):95-6.

Anahtar Kelimeler

• Karın ağrısı
• kabızlık
• radyoloji
• yeme bozuklukları

Kaynakça

1. 1. Kacprzyk A, Stefura T, Chłopaś K, Trzeciak K, Załustowicz A, Rubinkiewicz M, et al. Analysis of readmissions to the emergency department among patients presenting with abdominal pain. BMC Emerg Med. 2020;20(1):37.
2. 2. Watkins JW 4th, Lewis ZB. Diagnoses of Exclusion in the Workup of Abdominal Complaints.EmergMedClin North Am. 2021 Nov;39(4):851-863.
3. 3. Lameris W, van Randen A, Dijkgraaf MG, Bossuyt PM, Stoker J, Boermeester MA.Optimization of diagnostic imaging use in patients with acute abdominal pain OPTIMA: Design and rationale. BMC Emerg Med 2007;7:9.
4. 4. Loo JT, Duddalwar V, Chen FK, Tejura T, Lekht I, Gulati M. Abdominal radiograph pearls and pitfalls for the emergency department radiologist: a pictorial review. Abdom Radiol (NY) 2017;42(4):987-1019.
5. 5. Scheinfeld MH, Mahadevia S, Stein EG, Freeman K, Rozenblit AM. Can lab data be used to reduce abdominal computed tomography (CT) usage in young adults presenting to the emergency department with nontraumatic abdominal pain?.EmergRadiol2010;17:353–60.
6. 6. Hardwick RH, Armstrong CP. Synchronous upper and lower gastrointestinal endoscopy is an effective method of investigating iron-deficiency anaemia. Br J Surg1997;84:1725-8.
7. 7. Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet 2020;395(10227):899-911.
8. 8. Delaney CB, Eddy KT, Hartmann AS, Becker AE, Murray HB, Thomas JJ. Pica and rumination behavior among individuals seeking treatment for eating disorders or obesity. Int J Eat Disord 2015;48(2):238-48.

9. 9. Lam CL, Pan PC, Chan AW, Chan SY, Munro C. Can the Hospital Anxiety and Depression (HAD) Scale be used on Chinese elderly in general practice?. Fam Pract 1995;12(2):149-54.
10. 10. Ariza-Fernández JL, Úbeda-Muñoz M, Redondo-Cerezo E. Endoscopic retrieval of multiple large sharp foreign bodies from the stomach. Testing the limits of endoscopy. Gastroenterol Hepatol 2017;40(2):95-6.