Clinical Challenge: February, 2007

The patient is a healthy 38-year-old who presents with progressive abdominal pain. There is no fever, vom- iting, or diarrhea.
Upon examination, you find:

• No peritoneal signs
• Pulse is 55
• Blood pressure is 118/50

The only remarkable finding when the history is taken is that the patient had corrective heart surgery as a child.
View the x-rays taken (Figure 1 and Figure 2) and consider what your next steps would be. Resolution of the case is described on the next page.