Case Report: Man in 30s w/ Vomiting, Abdominal Pain, & Tenesmus

Our latest case report from Dr. Brady Pregerson features a man in his 30s presenting with vomiting, generalized abdominal pain, and tenesmus. Can you determine the correct diagnosis?

History:
A 30-ish-year-old male with no prior surgeries or significant medical history presents to the emergency department for vomiting, generalized abdominal pain and tenesmus. He denies any fever, diarrhea, bleeding, or other complaints. He said that he has had this a few times in the past but never this bad. He was hospitalized for it once, about 3 months ago, and they did not find a cause.

Vital Signs & Physical Exam:

Vital signs are normal except for a pulse of 118 and BP of 153/94. He is afebrile. A physical exam is otherwise normal except for severe apparent distress and retching into a bag. Except for mild epigastric tenderness the abdomen is benign.

Initial Diagnostic Testing:

CBC: WBC = 30

Chem 7: bicarb = 13, lactic = 6.5, glucose =181, potassium = 3.1, acetone level = 56

KUB: no acute disease

What is the most likely cause of these lab abnormalities in this patient?

  1. Bowel obstruction
  2. Alcoholic ketoacidosis
  3. Mesenteric ischemia
  4. Septic shock from bowel perforation
  5. Malingering