Delayed-onset and atypical left abdominal pain.

Abstract

A 42-year-old man was transferred by an ambulance with worsening intermittent pain in his left lateral abdomen. On arrival at the hospital, the patient showed no symptoms, and no abnormalities were found on the physical examination. The hemodynamic states were stable. The pain had persisted for more than a few years and other hospitals had been visited, but the cause was unclear. A simple abdominal radiograph was obtained (Figure 1). He had been injured in an accident over 2 decades ago; however, the details were unknown. Abdominal computed tomography (CT) revealed an abdominal wall hernia with the intestine and interstitial membrane interposition around the pelvic fracture (Figure 2). Subsequently, the patient was admitted to a hospital where surgery was possible. Sahdev et al reported the diagnostic standard that abdominal wall hernia occurs later in the history of trauma.1 Having a history of trauma (such as experiencing an accident that occurred several years earlier) and confirmed pelvic fracture led to the consideration of this diagnosis in the absence of symptoms, and an abdominal CT was performed. CT is the simplest, fastest, and most optimal imaging system during emergencies.