The Leading Diagnosis

A CLINICAL PROBLEM-SOLVING article by Thomas Baudendistel from California Pacific Medical Center in San Francisco.
A 23-year-old black woman presented to the emergency department with diffuse, colicky abdominal pain of 1 hour's duration. The pain was followed by nausea and episodes of bilious vomiting and did not radiate or change with the patient's position.
The patient reported that a similar episode had occurred 6 months previously. At that time, she passed red blood from the rectum once but did not seek medical attention.
On examination, she was restless and clutching her abdomen. Abdominal examination revealed hyperactive bowel sounds and a CT scan of the abdomen showed intussusception of a segment of small intestine.
On closer inspection, several small hyperpigmented lentigines were detected on the patient's fingers, tongue, and everted lips.