Episode #340: Woman With Severe Abdominal Pain After Sit-Ups
Mar 21, 2025
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Dive into a perplexing medical mystery involving a young woman suffering severe abdominal pain after exercising. The discussion emphasizes the challenges of diagnosing abdominal issues in women, crucial factors like pain location, and the role of imaging in uncovering mysteries. Learn about rectus sheath hematomas and their risk factors, plus the typically harmless nature of these conditions. The episode wraps up with reassurance on exercise safety and an engaging call for listener interaction.
The podcast highlights a unique medical case of a young woman experiencing severe abdominal pain after sit-ups, prompting discussions on differential diagnoses and anatomical considerations.
The resolution of the case revealed bilateral rectus sheath hematomas, underscoring the importance of recognizing the self-limiting nature of such conditions post-exercise strain.
Deep dives
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The Case Presentation
A medical mystery case involving a 28-year-old female with sudden, severe abdominal pain was introduced. The patient reported that the pain began after performing sit-ups, describing it as a 9 out of 10 in intensity and located under the belly button. Important medical history included previous Accutane use, but she had no significant gastrointestinal or urinary symptoms, and her last menstrual period was 20 days prior. As the case unfolds, the complexities of diagnosing acute abdominal pain, particularly in young women, become clear due to the numerous potential causes involved.
Differential Diagnosis of Abdominal Pain
A thorough method of approaching acute abdominal pain involves considering various differential diagnoses based on the patient's presentation and the anatomy of the abdomen. Given the patient's symptoms and their acute onset, significant considerations include vascular emergencies, intestinal obstruction, or ectopic pregnancy. The presentation stresses the importance of anatomical knowledge and recognizing that abdominal pain may not always correspond neatly with a single organ's condition. The discussion also emphasizes the need to rule out potential emergencies while evaluating the patient, ensuring timely and appropriate care.
Final Diagnosis: Rectus Sheath Hematoma
After conducting labs and imaging, it was determined that the patient suffered from bilateral rectus sheath hematomas, likely caused by the physical strain of sit-ups rather than a traumatic event. These hematomas are collections of blood in the abdominal wall and can commonly occur after mechanical causes, particularly in those with recent physical activity. The identification of this condition provides a clinical lesson on differentiating between abdominal wall and intra-abdominal pathologies, as well as understanding their presentations. The case concludes with reassurance about the self-limiting nature of this condition, emphasizing its rarity and the importance of awareness in clinical practice.
In this episode of The Barbell Medicine Podcast, Drs. Baraki and Feigenbaum discuss a mystery case of young woman who presents with severe abdominal pain after working out.
Got pain and need a professional who understands you lift? Or, do you need an experienced coach to help you get the most out of your training? Contact us at support@barbellmedicine.com
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