The Case of the Middle-Aged Conjurer With a Fatal Bellyache

Albert B. Lowenfels, MD


March 06, 2007


The patient was a prominent 52-year-old male entertainer who developed abdominal pain and fever after a blow to the abdominal wall.

The patient's fatal illness began during a performance in Montreal, Canada. While in his dressing room, preparing to go on stage, he talked with a student who asked whether or not it was true that the entertainer's abdominal musculature was so well developed that he could withstand strong abdominal punches. The entertainer invited him to try, and the student immediately landed several blows to his abdomen.

During his Montreal performance, the entertainer appeared to be in pain not only from his abdomen, but also from a recent ankle injury. He finished the performance, and then boarded a train for Detroit, where a sold-out audience awaited his next performance. Because the pain became much more severe, the patient wired ahead, asking for a physician to meet him on his arrival in Detroit.

About 48 hours later he arrived, feeling much worse. He was quoted as saying: "I'll do this show even if it's my last." Rather than disappoint the large audience gathered to witness his performance in Detroit, the performer, although acutely ill, immediately went on stage.

After performing, the patient returned to his dressing room where he complained of abdominal pain, which gradually increased and was accompanied by weakness. After struggling through his performance, he was examined by a physician.

The patent was a nonsmoker and nondrinker, but during his professional career he sustained many bruises and fractures. His most significant illness was a prolonged bout of hematuria from a suspected ruptured renal blood vessel.

The patient's father died at age 63 of cancer of the tongue. His mother died in her 70s from a stroke. He had five brothers and sisters, one of whom died from tuberculosis.

A muscular male below average in height, the patient appeared to be acutely ill, complaining of abdominal pain and tenderness, especially in the right lower quadrant. Other than the abdominal findings, the remainder of the physical examination was within normal limits. Initially his temperature was 102° F, but it soon rose to 104.

After the physician performed the initial examination, the patient was then examined by a surgeon, who recommended surgery. The patient underwent an emergency laparotomy approximately 72 hours after the initial onset of his illness.

Postoperatively he continued to be febrile, with a temperature of 101° F and rapid pulse, but was alert and responsive. Because of persistent postoperative ileus, he was reoperated approximately 4 days after the initial laparotomy. He failed to recover and died 10 days after the initial onset of symptoms.

What is your diagnosis?

  1. Perforated peptic ulcer

  2. Splenic rupture

  3. Appendicitis

  4. Acute pancreatitis

View the correct answer.

Who was our mystery patient?

  1. Rudolf Valentino

  2. Charlie Chaplin

  3. Ehrich Weiss

  4. Jerry Garcia

View the correct answer.


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