A 29 year old female with chest pain and abdominal distension.

The complete case can be found here

https://potlapallirashmitha.blogspot.com/2020/05/29-year-old-female-from-west-bengal.html?m=1

possible differential diagnoses

Based on first initial history of abdominal pain(assumed rapid onset), left sided stabbing chest pain, abdominal distension and loss of appetite differential diagnosis is broad

cholecystitis,

pancreatitis,

intestinal obstruction,

diverticulitis,

appendicitis,

ureteral stone,

penetrating gastric or duodenal ulcer.

reference: https://www.ncbi.nlm.nih.gov/books/NBK412/

More information about history and examination to reach the final diagnosis

site of pain and migration with time

Has the pain abated, or has it increased?

Have there been intervals of total absence of the pain, or has the pain always been present, changing only in character?

diarrhea,

constipation,

obstipation,

tarry stools,

urinary frequency,

hematuria,

jaundice.

investigation

pancreatic amylase, lipase to diagnose peritonitis

diagnostic laproscopy and peritoneal and omental biopsy

peritoneal paracenthesis

Diagnosis

chronic granulomatous omentitis is the biopsy picture which should be subjected to acid fast staining to coinfirm tuberculosis

CT/MRI to establish diagnosis

to assess pancreatic function

• Collection of pure pancreatic juice after secretin injection
• Pancreolauryl test

• Faecal pancreatic elastase

Management

anti tubercular treatment