Unusual cause of abdominal pain

Case presentation An 18-year-old woman presented with a 4-day history of worsening abdominal pain. Physical examination revealed tenderness in the left mid abdomen, without rebound tenderness. Laboratory workups revealed neutrophilia (10 890/µL), elevated C reactive protein (38.59 mg/L) and increased faecal calprotectin (>50 µg/g). Haemoglobin, liver function, renal function and urinalysis results were within normal range. Immunological investigations, including immunoglobulin levels, antineutrophil cytoplasmic antibodies and antinuclear antibodies, were all normal. An abdominal CT scan demonstrated wall thickening of the distal duodenum and proximal jejunum (figure 1A). To further evaluate the small intestine, a gastrointestinal barium contrast radiograph was performed, which confirmed dilatation of the horizontal duodenum (figure 1B). Consequently, supportive care measures were initiated, including nil by mouth, nasogastric decompression, antibiotic therapy (piperacillin sodium/tazobactam sodium, 4.5 g every 8 hours intravenously) and acid suppression with omeprazole. Despite these interventions, the patient showed no improvement, prompting the need for oesophagogastroduodenoscopy...
Source: Gut - Category: Gastroenterology Authors: Tags: GUT Snapshot, Gut Editor ' s quiz: GI snapshot Source Type: research