Abdominal pain – a common presentation with unusual diagnosis: a case report

Figures & data

Table 1. Laboratory values on presentation

Presentation Laboratory results		Reference Interval
Common Blood Count
White Blood Count	4.13 10 (3)/mcl	4.00–12.00 10 (3)/mcl
Neutrophils	69.3%	47.0–73.0 %
Lymphocytes	40.7%	18.0–42.0%
Monocytes	6.4%	4–12%
Eosinophils	1.7%	0–5.0%
Basophils	0.7%	0.0–1.0%
Red Blood Count	4.12 10 (6)/mcl	3.80–5.30 10 (6)/mcl
Hemoglobin	12.8 g/dl	12–15.8 g/dl
Hematocrit	36.7%	36.0–47.0%
Mean Corpuscular Volume	89.1 fL	82.0–96.0 fL
Platelet Count	224 10 (3)/mcl	140–440 10 (3)/mcl
Basic Metabolic Panel
Sodium	138 mmol/L	136 − 145 mmol/L
Potassium	3.7 mmol/L	3.5–5.1 mmol/L
Chloride	106 mmol/L	98–107 mmol/L
Bicarbonate	23 mmol/L	22–30 mmol/L
Anion Gap	9 mmol/L	<18.0 mmol/L
Glucose	86 mg/dL	70–99 mg/dL
BUN	7 mg/dL	5–18 mg/dL
Creatinine	0.69 mg/dL	0.60–1.00 mg/dL
Albumin	4.5 g/dL	3.5–5.0 g/dL
Calcium	9.9 mg/dL	8.4–10.2 mg/dL
GFR	>60	>60
Lipase	58 U/L	8–78 U/L
Urine Analysis
Specific gravity	1.020	1.003–1.030
Urine PH	7.0	5.0–9.0
WBC esterase	Negative	Negative
Nitrite	Negative	Negative
Random protein, urine	Negative	Negative
Urine glucose	Negative	Negative
Urine ketones	Negative	Negative
Urobilinogen	3.0 mg/dL	2.0 mg/dL
Urine bilirubin	Negative	Negative
Urine blood	Negative	Negative
Urine color	Pale yellow	Pale yellow
Urine Pregnancy Test	Negative	Negative

Table 2. Differential diagnosis for irritable bowel syndrome

Inflammation

Ulcerative colitis

Crohn’s Disease

Appendicitis

Diverticulitis

Microscopic Colitis

Infection

Giardia

Yersinia

Clostridium Difficile

Enterobius Vermicularis

Tuberculosiss

Campylobacter

CMV

Disease of Malabsorption

Celiac disease

Lactose intolerance

Pancreatic insufficiency

Small Intestinal Bacterial Overgrowth

Endocrine

Hyperthyroidism Diabetic autonomic dysfunction

Gynecological

Endometriosis

Drug Induced/Iatrogenic

NSAIDS

Laxative abuse

Antibiotics

Chemotherapy

Neoplasms

Colon cancer

Carcinoid tumor

Lymphomas

Pancreatic cancer

Figure 1. CT abdomen and pelvis. Enlarged, mobile cecum located in the left side of the abdomen. There is gaseous distention of the cecum without obstruction or evidence of rotational torsion/volvulus

Figure 2. Laparoscopic images of abdomen. Mobile right colon easily reaching the left lower quadrant, and loose right peritoneum

Figure 3. Histopathology. Solid arrow showing endometrial tissues, and the transparent arrow showing enterobius vermicularis in the lumen of appendix