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Unremitting abdominal pain: obscure until the first CT
  1. Ami Schattner1,2,
  2. Edith Feldberg2,3,
  3. Meital Adi2,4
  1. 1Department of Medicine, Kaplan Medical Centre, Rehovot, Israel
  2. 2Hebrew University Hadassah Medical School, Jerusalem, Israel
  3. 3Department of Pathology, Kaplan Medical Centre, Rehovot, Israel
  4. 4Department of Imaging, Kaplan Medical Centre, Rehovot, Israel
  1. Correspondence to Professor Ami Schattner, Department of Public Health, Ethox Centre, University of Oxford; amischatt{at}gmail.com

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Introduction

Chronic intermittent or steady abdominal pain in adults is commonly encountered and may be due to a large variety of syndromes many of them with no demonstrable anatomical abnormality (irritable bowel syndrome, functional dyspepsia), but some involving occult structural, neoplastic or inflammatory conditions that may present a considerable diagnostic difficulty. We present a patient with a clinical entity that deserves better recognition, first suspected by its typical imaging findings.

The case

A healthy elderly patient presented with several months’ history of diffuse abdominal pain of mild to moderate intensity becoming relentless with time with no associated weight loss, fever or anorexia. Examination, X-rays, laboratory tests, gastroscopy and colonoscopy were normal and no diagnosis was reached over several months.

On admission, abdominal CT revealed lymphadenopathy (up to 3.0×1.5 cm) and …

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