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An unusual cause of epigastric pain in a diabetic patient
  1. C-C Lee1,
  2. K-C Tsai2,
  3. C-M Fan2
  1. 1Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
  2. 2Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
  1. Correspondence to:
    Dr C-M Fan
    Department of Emergency Medicine, Far Eastern Memorial Hospital, 21, Nan-Ya S Rd, Sec 2, Pan-Chiao, Taipei, Taiwan; r92843017{at}ntu.edu.tw

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CLINICAL PRESENTATION

A 47 year old woman presented with a three day history of fever and epigastric pain. She had a past medical history of diabetes mellitus regularly controlled by oral hypoglycaemic agents.

Clinically, she had a temperature of 38.7°C. Tenderness could be elicited in the epigastrum and right upper quadrant. Blood investigations revealed a left shift leucocytosis (leucocytes 17980/mm3, neutrophil 88%), hyperglycaemia (capillary sugar 424 mg/dl), negative blood and urine ketone body test, normal serum amylase(6 U/l) and lipase (8 U/l) levels, and abnormal liver function tests (total bilirubin 10.3 µmol/l, alkaline phosphatase 274 U/l, gamma glutamyl transferase 258 U/l, aspartate aminotransferase 64 U/l, and alanine aminotransferase 136 U/l). Abdominal radiograph showed a large region of mottled radiolucency centred at the epigastrum (fig 1, arrow).

Figure 1

 Abdominal radiograph showed a large region of mottled radiolucency centred at the epigastrum (arrow).

QUESTION

What is the diagnosis? What are the pathogenetic mechanisms of this condition?

See page 528 for answer

This case is submitted by:

Footnotes

  • Robin Spiller, Editor

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