A Foreign Etiology of Abdominal Pain

Tim Simpson, Pharm.D, Joel Papak, MD 

December 30, 2015

A 74-year-old man with a history of congestive heart failure (CHF) and coronary artery disease with 3-vessel coronary artery bypass grafting (CABG) ten years ago, presented with two months of nonproductive cough, 10 pound weight gain, and worsening dyspnea on exertion consistent with prior CHF exacerbations for which he was hospitalized. He additionally complained of a 3 year history of severe, intermittent, sharp, left lower quadrant abdominal pain occurring nearly daily, which had worsened recently. Abdominal exam was notable only for mild diffuse tenderness with palpation.  A review of imaging included chest radiograph from this admission (left) compared with prior post CABG radiograph (right) (Figure 1), and recent Computer tomography (CT) of the abdomen without contrast. (Figure 2).  

References:

1. Reade M. Temporary epicardial pacing after cardiac surgery: a practical review. Anaesthesia. 2007;62(3):264-71. 

2. Shaikhrezai K, Khorsandi M, Patronis M et al. Is it safe to cut pacing wires flush with the skin instead of removing them? Interact Cardiovasc Thorac Surg. 2012;15(6):1047-51.

Biographies:

Tim Simpson is a fourth year medical student at Oregon Health and Science University, and is applying for residency in Internal Medicine.

Joel Papak is an attending physician at the Portland Veterans Affairs Medical Center and Assistant Professor of Medicine at Oregon Health and Science University.