[A rare differential diagnosis of acute abdominal pain--case 04/2009].

HISTORY AND FINDINGS: A 44-year-old woman was referred to the emergency department for acute paraumbilical abdominal pain with colics. 5 days previously, a tooth extraction had been performed and postoperatively ibuprofen had been prescribed for pain relief. The medical history was empty besides a penicillin allergy and two caesarean sections 20 and 21 years ago.

INVESTIGATIONS: The physical examination revealed paraumbilical pain on palpation. Abdominal ultrasound could identify some free fluid and an aperistaltic intestinal loop as well as an echo-rich structure in the hypogastric region. An abdominal CT scan showed a hypodense tubular structure of 6.5 x 3.3 cm indicating a possible ischaemic intestinal segment, and a dilated intestinal loop as well as an uterus myomatosis. Due to therapy refractory symptoms and increasing leucocytes on the second day after admission, a diagnostic laparoscopy was performed.

DIAGNOSIS: Intraoperatively, a volvulus of the ileum as well as an adhesive strangulation of the small intestine could be identified.

TREATMENT AND COURSE: Consecutively, surgery with an ileocoecal resection and a side-to-side ileotransversostomy was performed. Within a few days, the patient recovered completely and resumed normal activities of daily living.

CONCLUSIONS: In the evaluation of unclear acute abdominal pain, interdisciplinary cooperation is very important to ensure a fast and appropriate diagnosis and therapy as shown in our case.