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Internal and Emergency Medicine

, Volume 13, Issue 5, pp 713–715 | Cite as

On being an internist in emergency medicine: a rare case of epigastric pain

  • Annalisa Marchetti
  • Vincenzo Zaccone
  • Lorenzo Nobili
  • Cinzia Nitti
  • Aldo Salvi
IM - PHYSICAL EXAMINATION
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Below we describe the case of a 52-year-old man admitted to our Subintensive Medicine Department for epigastric pain extended to both sides of the abdomen and associated with severe constipation. Symptoms started 5 days before hospital admission.

His medical history reported benign prostatic hypertrophy, chronic leg vein insufficiency, and a previous surgical correction of bilateral inguinal herniae.

At arrival, the patient appeared awake, calm, and no neurological deficits were noted. His skin was pale and thin. A systolic bruit emerged on the right cervical and on the peri-umbilical regions. The abdomen was distended but soft, with reduced peristaltic sounds, but no pain was evoked by palpation. Cardiac tones were regular, without added tones or murmurs. His chest was slightly kyphoscoliotic with regularly conducted breath sounds in both sides. No crackles were recorded. We observed high blood pressure values (180/100 mmHg), which were reported since the beginning of symptoms.

Bedside...

Keywords

Vascular Ehlers–Danlos syndrome Carotid artery dissection Superior mesenteric artery dissection Critically-ill patient 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in this study involving human participant were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the patient at the discharge from our department.

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Copyright information

© SIMI 2018

Authors and Affiliations

  • Annalisa Marchetti
    • 1
  • Vincenzo Zaccone
    • 1
  • Lorenzo Nobili
    • 1
  • Cinzia Nitti
    • 1
  • Aldo Salvi
    • 1
  1. 1.Internal and Subintensive Medicine DepartmentAzienda Ospedaliero-Universitaria “Ospedali Riuniti”-AnconaAnconaItaly

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