A 19-year-old man presented to the emergency department with abdominal pain that began 3 hours previously. The pain had increased in severity and progressed to cramping, nausea, and vomiting. The patient denied having diarrhea, melena, hematemesis, syncope, dyspnea, or fever. Vital signs of the patient were a blood pressure of 119/85 mm Hg, a pulse of 86 beats per minute, a respiratory rate of 34 breaths per minute, and a temperature of 98.0°F (36.7°C). The patient's white blood cell count was within normal parameters.
Head, neck, and cardiothoracic examinations of the patient yielded normal findings. His abdomen was mildly protuberant with normal bowel sounds and diffuse tenderness with voluntary guarding. Results of rectal, genital, extremity, and neurologic examinations were all unremarkable.
A review of the patient's medical history revealed recurrent attacks of abdominal pain or discomfort since the age of 11 years. At age 14 years, these attacks became severe enough to warrant hospitalization once or twice per year. The patient's father had experienced similar episodes, which resolved spontaneously after several days regardless of treatment.