A 50-year-old man presented with epigastric and left upper quadrant pain. He had a history of pancreatitis due to gallstone disease, after which he had undergone laparoscopic cholecystectomy. Examination showed tenderness in the epigastrium and left upper quadrant, but no mass. Laboratory studies, including lipase and a CT scan of the abdomen, confirmed non-necrotic pancreatitis without abscess formation or pseudocyst.
The patient's clinician examined him every day while he was in the hospital. An examination of the abdomen on one occasion when the patient was wearing his hospital gown revealed a sensation of crepitus in the upper abdomen. Worried about development of subcutaneous emphysema from necrotizing pancreatitis, the examiner removed the hospital gown to fully inspect the abdomen. Instead of ecchymoses and subcutaneous emphysema, there was stubbly hair on the abdomen. There was no crepitus. Replacing the hospital gown resulted in the sensation of crepitus once more. The patient remarked that he periodically shaved various parts of his body, including his abdomen, due to excessive hair growth.
It appears that stubble bristling on a hospital gown yielded the false sensation of crepitus. This experience serves to remind clinicians that it is always best to remove the patient's clothing before performing an examination.
Richard Schreiber, MD, FACP