Sudden Midnight Upset Syndrome?

A 66-year-old woman without pertinent medical history presented to our outpatient clinic after experiencing sudden, episodic episodes of abdominal pain, followed by nausea and vomiting in the middle of the night.This only occurred during sleeping hours.Symptoms occurred periodically over a 10-year period and she visited several hospitals, but no causative diseases were identified.We first list the differential diagnoses of abdominal pain.It is not necessarily the case that the location of the abdominal pain will indicate the cause, but we classify them by location (Table 1). 1 Diseases which present right upper region pain include disorders of the organs of the right upper quadrant, such as the liver, gall bladder, and right kidney.Referred pain from the right lung or right rib fracture should also be taken into consideration.Musculoskeletal and dermal origins are frequently encountered with right upper region pain, but such diseases can involve any area of the body, so we discuss them later.Epigastric pain is associated with the stomach and duodenum.Acute or chronic pancreatitis usually involves epigastric pain, commonly accompanied by back pain.The early phase of acute appendicitis is frequently marked by epigastric pain.Life-threatening cardiovascular disorders should also be considered, including acute myocardial infarction, aortic dissection, and aortic aneurysm, when we see a patient with epigastric pain, particularly those with cardiovascular risk factors.Anisakiasis may also be associated with pain in the epigastric region.Left upper pain may be associated with acute pancreatitis, splenic infarction, pleuritis, urolithiasis, and rib fracture.Splenic infarction generally shows a sudden onset.Pleuritis, urolithiasis and rib fracture are possible if the affected parts are on the left side.Acute appendicitis and diverticulitis appear as right lower pain.Pain due to acute appendicitis frequently migrates from the epigastric region to the right lower region.Umbilical pain is generally associated with acute cystitis and irritable bowel syndrome.If the patient is female, ectopic pregnancy and endometriosis may be causes.Irritable bowel syndrome, diverticulitis, sigmoid volvulus, ischemic colitis, obturator hernia, and colon cancer should be taken into consideration for patients with left lower pain, along with ovarian cyst torsion in women.Many diseases are associated with abdominal pain not involving a specific region, such as ileus, constipation, peritonitis, mesenteric artery thrombosis, Crohn's disease, and ulcerative colitis.These diseases occur