A 16-year-old girl presents to the local health department with 3months of abdominal pain and swelling that increase in intensity after meals, with early satiety and bloating. She also has had a recent increase in urinary frequency, with a need to get up once at night. She denies polydipsia, dysuria, or flank pain. She continues to have a healthy diet and soft stools twice daily. She has gained 4.5 kg in the previous 4 months without trying to do so; she does not mind the weight gain but is concerned that it is all around her abdomen. She has increased fatigue but otherwise feels fine. She denies emesis, making herself vomit after meals, or ever being sexually active. She has had regular 4-day menstrual periods since she was 12 years old, with her last period 2 weeks prior to presentation. Physical examination reveals a firm, nontender, distended abdomen with no definite mass palpable. The remainder of the physical examination is unremarkable. Her urine is negative for β-human chorionic gonadotropin (BHCG), and a kidney-ureter-bladder abdominal radiograph reveals normal bowel gas patterns but displaced bowel and upper abdominal solid viscera (Figure 1).
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