Monday, August 2, 2010

Tic-Tac-Toe I

This is the first part of a two-part case.

A 70 year old man presents with left lower quadrant abdominal pain of several days. He's had this in the past but previous episodes were mild and he's always ignored the symptoms. This time, though, he also has nausea, vomiting, and constipation. The patient has left lower quadrant tenderness with a palpable mass and abdominal distention. He has a mild fever and leukocytosis. LFTs and amylase are normal.

Challenge: This patient is not Asian. If he were Asian, how might the symptoms differ?

Image is in the public domain.


tree said...

Tics! Asians tend to have right-sided diverticula, whereas the most common site in the general population is the sigmoid.

Craig Chen said...

exactly right!
Tic-Tac-Toe I

The image shows diverticula (or "tics"); the clinical case suggests diverticulitis. 70% of diverticulitis in Western countries occurs with left lower quadrant pain; however, 75% of diverticulitis in Asians occurs with right lower quadrant pain.

Source: UpToDate; Wikipedia.