Grand Rounds: The Great Masquerader- GYN Edition

February 26, 2019

Between 5 and 12 percent of emergency visits to hospitals in the US are for complaints of abdominal pain. The cause can range from something as simple as indigestion to a ruptured colon. The difficult part for medical staff is knowing how to diagnose this common ailment.

Women, especially those who are sexually active and within childbearing age, add in another level of possible explanations for the discomfort.

Drs. Kristine Graettinger, Nicholas Ruth and Nathan Boles discussed a case involving a patient who came to DCH Regional Medical Center emergency facilities complaining of severe lower left abdominal pain at a Grand Rounds presentation held by the College of Community Health Sciences.

During the presentation, the doctors led medical students, resident physicians, DCH medical staff and University Medical Center physicians through the process of diagnosis in this complicated case. The College operates UMC.

The onset of the patient’s pain occurred during intercourse, which led the team to believe that the cause could be pelvic inflammatory disease, a condition that affects 1 million U.S. women every year. However, despite receiving treatment the patient worsened.

Graettinger, chair of the College’s Department of Obstetrics and Gynecology, warned the audience against tunnel vision directed toward a specific diagnosis.

“It’s important to look at all the scans, lab results, patient history and your own physical assessment,” said Graettinger, who also cares for patients at UMC.

After the patient’s doctors consulted with colleagues across multiple departments, the patient underwent surgery to treat what was found to be diverticulitis with focal perforation and marked abscess formation. In short: a packed sigmoid colon from frequent constipation that had turned toxic and had to be removed.

The College’s Grand Rounds program, which provides Continuing Medical Education for physicians and other health professionals, is designed to help medical professionals and learners look at past cases and learn from the investigative process. In this case, the doctors assigned had to step back and look at all the information while using a hands-on approach with the patient to make a successful diagnosis.