Two days later, the patient returned to the emergency
department with the same complaints. At physical examination,
the abdomen was soft and diffusely tender, without rebound or peritoneal signs but with a vague epigastric mass.
Rectal examination revealed a positive screening fecal occult
blood test and loose stool in the vault, but no masses. Laboratory
tests revealed a white blood cell count of 9900/L with
no left shift, electrolyte derangement consistent with metabolic
alkalosis, and serum amylase and lipase levels within the reference
range.
Two days later, the patient returned to the emergencydepartment with the same complaints. At physical examination,the abdomen was soft and diffusely tender, without rebound or peritoneal signs but with a vague epigastric mass.Rectal examination revealed a positive screening fecal occultblood test and loose stool in the vault, but no masses. Laboratorytests revealed a white blood cell count of 9900/L withno left shift, electrolyte derangement consistent with metabolicalkalosis, and serum amylase and lipase levels within the referencerange.
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