Case 24-1965

Presentation of Case First admission. A sixty-nine-year-old woman was admitted to the hospital because of abdominal swelling. She had been well until nine months previously, when there was the onset of nervousness, nausea, vomiting and marked loss of weight. She had been constipated for many months, and four days before admission abdominal swelling developed. There was no history of pain in the abdomen, jaundice, melena or diarrhea. Physical examination revealed a thin, pigmented woman who appeared chronically ill. A few atelectatic rales were audible at both lung bases. The heart was not enlarged, and there were no murmurs. The abdomen . . .