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Young patient with periumbilical pain
  1. Konstantinos Parperis1,2,
  2. Christina Flourou3
  1. 1 Maricopa Integrated Health System, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
  2. 2 Medicine, University of Cyprus Medical School, Nicosia, Cyprus
  3. 3 Nicosia General Hospital, Leukosia, Leukosia, Cyprus
  1. Correspondence to Dr Konstantinos Parperis, Maricopa Integrated Health System, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85012, USA and University of Cyprus, Medical School, Cyprus; kparperi{at}email.arizona.edu

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Clinical introduction

A 32-year-old woman with a medical history of deep vein thrombosis (DVT) presented to the ED with a 2-day history of gradually worsening periumbilical pain. She denied fever, nausea, vomiting or diarrhoea. On examination the patient was found to have dilated veins on the anterior thoracic and abdominal wall with tenderness on periumbilical area (figure 1). Murphy’s sign and McBurney’s sign were negative. No ascites was detected. Complete blood count, liver and renal function tests, lipase and urinalysis were all in the normal reference range. CXR showed dilation of upper mediastinum.

Figure 1

On inspection the patient had dilated veins on the …

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