Recurrent Abdominal Pain in an Asian Female

Chun-Han Lo

March 4, 2016

A 53-year-old Asian woman was brought to our ER for sudden onset epigastric and RLQ pain without remission for one day. She denied weight loss and change in bowel movements. She reported the occurrence of similar episodes in the past that were milder in severity and subsided after taking analgesics. Physical examination showed flat soft abdomen with normal bowel sounds and mild tenderness over RUQ & RLQ areas. Computer tomography (CT) of the abdomen with contrast revealed numerous serpiginous calcifications within ascending colon and in adjacent mesentery (Figure 1). She was treated with diet limitation, hydration, empiric antibiotics and pain control during her admission. She was subsequently discharged after recovery.

However, the patient was troubled with persistent abdominal pain with occasional bloody stool during the follow-up period despite conservative treatment. Thus abdominal echo and colonoscopy with transverse colon biopsy were arranged. Abdominal echo showed thickened colonic wall. Colonoscopy showed dark purple and edematous mucosa accompanied by ulcers and a narrowed lumen (Figure 2). She presented to our ER one year after her last admission with worsened RLQ pain and fever for 1 week, conservative treatment was considered ineffective. Results of abdominal CT study in the ER were consistent with previous diagnosis. She was admitted to our medical ward. Upon further questioning the patient, she informed us that she had been taking a particular brand of Chinese herb for over 5 years. This time in addition to diet limitation, hydration, antibiotics and pain control, we arranged laparoscopic right hemicolectomy to remove the involved colon. The patient recovered well from the surgery and was regularly followed up in the outpatient department.

Figure 1

Figure 2

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Reference:

1. Yao T, Iwashita A, Hoashi T, et al. Phlebosclerotic colitis: value of radiography in diagnosis—report of three cases. Radiology 2000; 214:188 –192
2. C. H. Wang, T. Y. Chen, J. Chin, Y. J. Wu, M. T. Wang. Phlebosclerotic Colitis: A Case with a history of Herbal Ingestion. J Soc Colon Rectal Surgeon (Taiwan) 2012;23:129-134


Biography:

Chun-Han Lo is a 6th year medical student from Chung Shan Medical University School of Medicine, Taichung, Taiwan.