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BACKGROUND A 75-year-old man presents to the primary care clinic with a 4-week history of progressive abdominal swelling and early satiety after meals. He also complains of mild persistent nausea. He has no history of fevers, shortness of breath, or leg swelling, though he had a long history of alcohol use until about a year ago, when he had an episode of acute alcoholic pancreatitis. He subsequently stopped drinking alcohol.
Physical examination reveals mild pallor in the patient's general appearance with a blood pressure of 178/94 mm Hg, pulse of 84 beats per minute, respiration of 20 breaths per minute, and a temperature of 96.8°F. No icterus, cyanosis, or clubbing is identified. The patient's abdomen is distended, and he has tenderness to palpation on the left side. Laboratory examination reveals a WBC count of 7.0 X 109/L (7000 cells/µL), a hemoglobin concentration of 11.0 g/dL, hematocrit of 37, and platelet count of 220 X 109/L (220,000/µL). Results of liver function tests, including bilirubin levels, are normal. Serum amylase and lipase values are also in the normal ranges.
What is the diagnosis?
Hint
The patient was hospitalized 12 months ago for alcoholic pancreatitis.
Author: Gautam Dehadrai, MD, Department of Radiology, Norman Regional Hospital, Norman, Okla
eMedicine Editor: Rick G. Kulkarni, MD, Assistant Professor, Yale School of Medicine, Section of Emergency Medicine, Department of Surgery, Attending Physician, Medical Director, Department of Emergency Services, Yale-New Haven Hospital, Conn
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