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Abdominal Pain of Elusive Nature

Alan Furness White, MD
JAMA. 1971;217(3):329. doi:10.1001/jama.1971.03190030055012.
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Dr. White: This 52-year-old man had a four-month history of abdominal pain in the right upper quadrant, radiating to his back. There had been a 12.2-kg (27-lb) weight loss and, for three years, intermittent diarrhea. Results of physical examination and laboratory tests, including liver function, were normal, as were roentgenograms of the dorsal spine, intravenous pyelograms and cholangiograms, and a gallbladder series.

Discussion  Dr. Jack R. Dreyfuss: The second portion of the duodenum does not appear normal; it is slightly wider than it should be when distended, and the fold pattern is thickened and irregular. The final diagnosis in this case may be carcinoma of the pancreas, but at the moment I can only be sure that there is slight irregularity of the duodenal folds in an otherwise normal gastrointestinal tract. I would like to see a hypotonic duodenogram.Dr. White: There was no duodenogram, but celiac and superior mesenteric


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