Volvulus during coitus.

case Report A 46-year-old woman came to the emergency department complaining of severe, sharp, upper abdominal pain that had begun less than 1 hour earlier. The most notable aspect of her history was that the abrupt onset of this excruciating pain occurred within 5 minutes after coitus. The pain was the most severe she had ever experienced. She described it as steady, burning, and located vaguely in the upper abdomen without radiation. She had no history of abdominal surgery. Her medical history was unremarkable. Her obstetric history was gravida 2, para 2, aborta O. Her last menses was 5 months prior to admission. She denied past gynecologic problems. The patient was in extreme distress when first seen. On examination, she responded with moderate guarding to abdominal palpation, and she had mildly decreased bowel tones, but there was no mass, tenderness, or hernia. Results of a pelvic examination were normal except that lateral motion of the cervix elicited mild discomfort, which radiated to the area of her pain in the epigastrium but did not exactly reproduce her symptoms. Admission laboratory data were as follows: leukocytes 17,300/mm3 with normal differential counts hematocrit 40.3 percent, and normal serum a~ylase levels, erythrocyte sedimentation rate and electrolytes. Findings on urinalysis were no~. A pregnancy test was negative. Res~ts of abdominal radiographs showed no free aIr or